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  • Barbara Hoefener NP


Written by Barbara Hoefener, FNP 8/2021


Testosterone is a hormone with many body functions. Primarily as an Androgen Hormone, which helps with puberty, metabolism, muscle and bone strength. Both males and females have testosterone and it needs to be balanced. In females, testosterone is an estrogen precursor, as well as having anabolic effects and influencing behavior. Testosterone is mainly secreted from the testes or ovaries, minorly secreted from the adrenal gland and peripheral tissues. In men, testosterone levels increase from puberty to adulthood and then progressively decline starting by the fourth or fifth decade of life

Deficiency in Testosterone = Hypogonadism has symptoms including lower sex drive (males and females) with erectile dysfunction, weight gain, anemia, decreased bone density and lean body mass, increased body fat, sweating, lethargy or low energy, inability to focus, “brain fog,” anxiety and depression. Also, low testosterone increases risk of heart disease, osteoporosis, and insulin resistance. Common cause is obesity and drug use. In females, testosterone drops after menopause.

High/ Excessive Testosterone- is also not ideal as it will lead to faster puberty in boys and girls, as well as a decrease in sperm count, decreased testicle size, acne, hair and infertility. Common cause is adrenal tumor, testicular or ovarian tumor, or anabolic steroid use. Genetic Condition- Congenital adrenal hyperplasia


Guidelines published by the Endocrine Society in 2010, recommend against screening asymptomatic patients. They do recommend considering testing for specific patients at higher risk for androgen deficiency related to comorbid diseases (Diabetes, COPD, Obesity, etc).

People who smoke, drink alcohol, have vascular disease or have BMI>30, sleep apnea or diabetes can show symptoms of low testosterone, but the cause is not testosterone.


Testing: Total and Free Testosterone (T), FSH, LH and SGBH.

Free testosterone – unbound, not attached to other molecules or proteins. The body actively uses Free T molecules from the bloodstream. This makes Free T a better predictor of deficiency symptoms. Ranges in males per age, but average is 3-19

Total testosterone- measure of testosterone concentration you have in your blood both Free T and Bound T. Most testosterone is mainly bound to sex hormone binding globulin (SHBG), with some bound weekly to albumin thus being bioavailable= able to dissociate freely in the bloodstream to be available for the body tissues. Adult males range form 240-950 and females 8-60 depending on the lab. Early morning testosterone is on average 50% higher than evening levels. Testosterone does fluctuate substantially between days.

Trough levels should be within normal range, Peak levels should also be within normal range or slightly high. Females should always remain within the normal ranges.

Other tests: FSH (Follicle stimulating hormone) & LH (Luteinizing hormone)

SHBG (Sex hormone binding globulin)- there will be a difference in bioavailability/ Free T vs total testosterone, with one being higher. Affected by corticosteroids, conjugated estrogen, liver disease and severe systemic illness.


Primary hypogonadism (late onset hypogonadism) = Low testosterone, High FSH/LH

Secondary Hypogonadism (disorders of the pituitary or hypothalamus) = Low Testosterone, low/normal FSH/LH


Feel better

Hypogonadism - Normalization of serum testosterone and LH.

PCOS- females are typically managed w androgen therapy.


First- rule out breast cancer, prostate cancer, heart failure, cardiovascular risk and polycythemia (HCT<55%). If you have BPH or sleep apnea, I will ask your specialist for clearance also.

Testosterone therapy

Weight control- get in shape.

Monitor= Checking Testosterone, PSA and CBC every 3 -6 months. We will routinely monitor for in range testosterone, along with any increase in your Hematocrit (by 50%) and/or prostate-specific antigen (PSA) levels (by 1.4ng/ml or >19).

Of Note:

Potential side effects of TRT include fluid retention, acne, sleep apnea, gynecomastia, and infertility.

Dependent on testosterone? – Yes, the body does stop making testosterone while you are on this, however you would take testosterone medication as a supplement as your body is no longer creating enough to balance you naturally.

Testosterone is classified as a controlled drug, level 3 – “drugs with a moderate to low potential for physical and psychological dependence” per the DEA. Yes, it is a controlled drug which has the auto definition of drug of abuse.




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