You’ve been slowly monitoring yourself since you noticed the symptoms of low testosterone, spending weeks trying to figure out why you’re suddenly experiencing fatigue and low sex drive every time you’re around a sexual partner. Every time you take a step, you can feel your body getting heavier thanks to the extra pounds that have appeared out of nowhere and added to your body weight. And for weeks, you’ve realized that your hair has gotten considerably thinner, despite the fact there’s no history of baldness in your family, and you’re still relatively young in your 30s.
Now, you’re worried and ready to see a doctor, but you’re unsure where to go. Many questions arise as you consider whether or not your physician may understand your condition and can help you solve the problem:
“Does my primary care physician know anything about low testosterone?”
“Will they be able to provide the right testing to accurately determine whether or not the low testosterone is the cause of my symptoms?”
“And if I am diagnosed with low testosterone, can they provide me with the necessary treatment?”
If you’re already asking yourself these questions, your mind is moving in the right direction. And if you have already started monitoring your symptoms, then you more than likely have some base knowledge about low testosterone. But if you’ve only read about the symptoms, it may help to learn more about the condition so you can prepare for what’s to come after you find the right physician.
Let’s assume you already know that testosterone is an essential hormone in the male anatomy. If you remember anything from school, you already know that testosterone is the primary sex hormone that helps you to develop your facial hair, muscle mass, penile size, and of course, your sex drive. If that’s the case, then you’re also already aware that testosterone has played a major role in maintaining your metabolism and weight distribution, helping to break down those extra calories from the food you eat and making sure that your body doesn’t allow excess fat to build-up and lead to weight gain. But now that you’re a bit older, things have changed.
Although it’s natural for testosterone levels to naturally decline as men transition to middle age after their thirties, it is usually abnormal for testosterone to fall below the normal parameters for a man’s age. In these cases, unusually low testosterone levels typically indicate a testosterone deficiency or low testosterone.
Low testosterone is a common medical condition that occurs when the testicles are unable to produce enough testosterone needed to regulate the cellular and biological processes necessary to maintain a man’s physical function as they age. As a result, the male anatomy will typically begin to exhibit a range of symptoms, including the low sex drive, fatigue, and increased weight gain that you’re experiencing. These symptoms can appear out of nowhere as the result of various underlying medical issues, so it’s extremely important that you visit the right physician to determine whether or not you’re truly suffering from low testosterone.
How to Diagnose Low T
Of course, the first step in diagnosing Low is getting yourself tested. Typically, this requires a special type of blood test known as a serum testosterone test. Since T levels are usually at their highest in the morning, the test is usually performed early in the morning, between 7 am and 10 am. Luckily, this is something that most primary care physicians can easily perform, even if they’re not experts at dealing with cases of low testosterone.
However, just in case your physician doesn’t have extensive knowledge about testosterone testing, you may want to learn more about the process yourself so you can make sure that your doctor requests the appropriate testing to get a complete picture of your testosterone levels.
The first thing you need to know is the difference between your free and total testosterone. But to understand the differences between the two, you first need to understand the definition of bound and unbound testosterone.
Bound testosterone refers to the 98% of testosterone attached to sex-hormone globulin and albumin proteins, which helps to regulate how much testosterone the body uses and transports throughout the bloodstream. Although bound testosterone may travel through the body, most of it typically remains inactive after it’s attached to SHBG and is only used as a reserve when your hormone levels get too low. However, testosterone’s bond with albumin is a bit weaker than its attachment to SHBG, so any testosterone bound to albumin has the potential to become more active and available for use when the body is drawing from its bound reserves. This is also known as bioavailable testosterone.
Unbound (Free) Testosterone
On the other hand, unbound testosterone refers to the 2% of your remaining testosterone left unattached to any proteins and is actively available for the body to use at any time. Due to its availability, unbound testosterone can interact with any receptor site on a cell in the body and help facilitate the cellular functions of that cell, whether it involves regulating metabolism or developing muscle growth. The available testosterone is primarily responsible for all the secondary physical characteristics that define your body’s function and, in essence, your manhood. If you haven’t already guessed, this unbound and active form of testosterone is your free testosterone.
Then, there’s your total testosterone. As the name suggests, total testosterone is the total amount of testosterone found in your blood, including both your bound and free testosterone.
Testing Your Total and Free Testosterone
Now that you have a little knowledge about total and free testosterone, let’s discuss how this is important to diagnosing Low T.
Total testosterone tests are typically used to determine the amount of testosterone concentration in the blood, which can help reveal whether your testosterone levels are too high, or in the case of testosterone deficiency, too low. Now, although that can work as a good indicator to assess the status of your testosterone levels, there are some drawbacks to relying on it as the sole determining factor concerning your symptoms.
For example, a physician may check your total testosterone only to find that you have normal levels, despite your symptoms. However, that doesn’t mean you’re not suffering from low testosterone. In many of these situations, your bound testosterone may be excessively bonded to SHBG, which can decrease the amount of free testosterone needed to perform many of the functions responsible for developing and maintaining your physical characteristics. A decline in your free testosterone production can lead to some of the symptoms you’re experiencing, such as reduced muscle mass, lowered sex drive, mood changes, and other symptoms that are the most common signs of testosterone deficiency. This means you could have normal total T levels but still suffer due to low levels of free testosterone. Unfortunately, this can lead your doctor to diagnose the cause of your symptoms inaccurately, which is why a free testosterone test is of equal importance.
A free testosterone test only focuses on measuring the active form of your testosterone and is often used to confirm the presence and cause of your low testosterone symptoms. This can also help to provide more context into the underlying issues that may be causing your free testosterone levels to decrease, which can also assist your healthcare provider in creating a game plan to treat those conditions to raise your free testosterone levels.
What Should I Ask My Primary Care Physician About Testing?
Now that you have some more extensive awareness of the types of tests you’ll need, let’s return to the discussion of talking to your doctor. Although issues with low testosterone have been around for decades, modern science and medicine have just started to recognize testosterone deficiency as a serious medical condition that can have debilitating effects on your health. That said, many primary care physicians are usually unaware of the testing required to diagnose it properly.
As we’ve mentioned, your primary care physician may not have extensive knowledge on the subject, so you’ll need to be proactive and request the proper testing. When your physician is preparing to request lab work to check your testosterone, ask them to check for total and free testosterone, so you can receive a complete picture of your testosterone levels. In addition, you may also need to ask them to check for other biomarkers, such as SHBG, albumin, estrogen, and estradiol, to determine if other hormones have been affected and may be interfering with your testosterone production. Naturally, these tests can easily be administered by your primary doctor, but if they’re untrained in understanding the results, they may decide to refer you to a specialist who can decipher the tests and make recommendations. In many cases, even if your test results indicate that you have low testosterone levels, primary care physicians are unable to provide the appropriate treatment for Low T and will usually refer you to a specialist for low testosterone treatment.
What Type of Doctor Treats Low Testosterone?
Testosterone is a primary sex hormone that is mainly produced in the male gonads or testicles. Since testosterone is a hormone and a product of the reproductive system, treating low testosterone typically requires the help of physicians who specialize in hormone-related medical conditions and diseases involving male sex organs. In most cases, this usually falls into the hands of a urologist or endocrinologist.
A urologist is a medical provider that specializes in the study, testing, and treatment of disorders and conditions involving the male urinary and reproductive system. They usually have advanced training in treating certain disorders–such as low testosterone–that may be caused by issues within your reproductive organs. Typically, the most common reproductive issue that causes low testosterone is hypogonadism, a condition in which the testes produce very little to no testosterone. However, other issues such as injury, trauma, and even benign tumors found on the testicles can also have a negative effect on your testosterone and cause your levels to decrease.
When you’re referred to a urologist for low testosterone, they will usually examine your testicles and penis to check for any unexplained lumps or growths. They may also request a CT or an MRI to check for any tumors or growths on the pituitary gland or the hypothalamus to see if they are causing your testosterone levels to decrease. However, if your low testosterone levels are unrelated to your reproductive system, a urologist may refer you to an endocrinologist so they can take a deeper look at your hormone levels and find the underlying issue that’s causing their decline.
An endocrinologist is a physician that specializes in diagnosing and treating diseases and disorders involving that make up the endocrine system, the vast network of glands responsible for secreting the hormones needed to regulate your body’s many biological functions. They typically handle various types of gland disorders and hormone-related conditions such as thyroid dysfunction, diabetes, growth hormone deficiency, infertility, and low testosterone. Your endocrinologist will also perform a blood serum testosterone test to check your testosterone levels and may also request an imaging test to see if there’s damage to the pituitary gland or hypothalamus that the urologist may have missed. Once they determine the cause of your low testosterone, your endocrinologist will try to focus on how to correct the underlying issue before prescribing a testosterone treatment, either in the form of pellets, gels, patches, or injections.
How to choose your Doctor
Now that you’re a bit more educated on low testosterone and the kinds of physicians that can help you with treatment, it’s time to choose a doctor. Depending on the cause of your symptoms, your primary care physician or one of the specialists we mentioned may decide which doctor would be the best to treat your case. Although endocrinologists are usually the physicians that prescribe testosterone medications for Low T, they may feel that it’s wiser to refer you to a Low T center that focuses on providing more comprehensive hormone treatment for men, like testosterone replacement therapy (TRT).
However, that doesn’t mean you don’t have a choice in the matter. If your healthcare provider suggests that you undergo therapy, there are still several factors you need to consider before placing your trust in a TRT doctor.
First, you must consider how long your potential TRT physician has been treating patients with low testosterone and how many they have treated. Although this doesn’t necessarily mean they aren’t proficient at treating low testosterone, it can provide some insight into their level of expertise and experience.
Second, you’ll need to ask about the treatment options that they provide. Many TRT clinics may prescribe injectables, creams, pellets, gels, or patches to help provide your body with additional testosterone to boost your testosterone levels; however, many TRT experts agree that administering testosterone injections is the most effective and inexpensive method for delivering testosterone into the bloodstream. Of course, if you’re uncomfortable with needles, you can always try nasal sprays or long-acting testosterone pellets as an alternative, but just remember they may not be as effective as testosterone injections. If the TRT doctor you’re visiting doesn’t offer injections, you may need to consider finding another physician.
If it turns out that they do offer injections, you should ask how frequently you will need to visit the office to receive them. Depending on the dosage schedule needed to treat your condition, you may need to visit the office once or multiple times a week to get treatment. This can be tedious for some people, so many TRT doctors usually allow their patients to self-administer their injections at home. If the dosing schedule your doctor prescribes seems to be overbearing and they won’t allow you to self-administer at home, that may also be a sign that you need to look elsewhere.
Third, you will want to ask your physician about the pharmacies they work with and the type of testosterone medication they offer. This is equally important as testosterone cypionate and testosterone enanthate are the two most common and effective forms of testosterone medication used in TRT. If they don’t mention these medications, you may want to continue your search.
ypically, physicians work with specific compounding pharmacies that provide testosterone medication, but the medicine may be more expensive going through your doctor if they don’t accept insurance. In these circumstances, it may be better to receive a prescription from your physician and shop for a pharmacy that can provide a generic version of your testosterone prescription at a cheaper rate. If your physician doesn’t offer that option and will only allow you to purchase the medication through their compounding pharmacy, then once again, you may need to find another physician who does.
When looking for a TRT doctor, it’s best to search for seasoned specialists who aren’t afraid to answer any questions you may have about TRT therapy and are willing to work with your requests to provide the best treatment, like the medical professionals at Renew Vitality. Our staff conducts both total and free testosterone testing to get an accurate picture of your testosterone levels. We also focus on the underlying medical condition that may be causing your Low T symptoms and will refer you to the necessary specialist to help you correct the issue before prescribing testosterone treatments. If it turns out that testosterone medication is indeed needed, we also provide testosterone cypionate injections to help boost your T levels and create a customized plan to help your body adjust to the therapy so you can maximize the results of your treatment.
The physicians, nurse practitioners, and wellness experts at Renew Vitality are dedicated to providing high-quality care and a safe and comfortable environment for our patients. Contact us at 1-800-785-3945 and schedule a consultation at any of our hormone replacement clinics in the United States to receive the best treatment possible for your low testosterone.