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Subclinical Hypogonadism and Relative Androgen Deficiency are conditions characterized by low testosterone levels, yet they differ significantly in their clinical presentation, diagnosis, and treatment approaches. There is a good deal of confusion in the medical community between these two conditions as traditionally, general practitioners steer clear of dealing with hormone therapy, however there is a new trend of specialists focusing on these patients due to the importance of having optimized testosterone levels and the impact that it has on overall health and wellness. Often, we receive calls from men who want to get tested and treated with TRT because their primary care doctors ignored their pleas for help and minimized the patients concerns over their hormone levels. We hear that physicians will often tell patients that their levels are still within “normal testosterone ranges for men” and they don’t need testosterone despite the evidence that shows dramatic improvements in quality of life for men who have optimized hormone levels.

Subclinical Hypogonadism

Subclinical hypogonadism is marked by borderline or mildly low testosterone levels with few or no overt symptoms typically seen in classic hypogonadism. Often detected incidentally during routine blood tests, it affects both young patients with a history of testicular damage before puberty and older men experiencing age-related testosterone decline. The significance of age-related secondary hypogonadism is debated, although it is linked to poor health outcomes and increased cardiovascular risks. For this reason, testosterone therapy may be a good option to improve both overall health and quality of life.

Diagnosis of Subclinical Hypogonadism

Blood Tests: Measure serum testosterone levels, typically in the morning when they are highest and SHOULD take into account both free and total testosterone levels.

Repeat Testing: Confirm low testosterone levels with multiple tests, as levels can fluctuate due to factors such as stress, medications, diet, sleep and time of day.

Hormone Analysis: Assess levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to distinguish between primary (testicular) and secondary (pituitary or hypothalamic) hypogonadism. Sex hormone binding globulin can help a physician determine how much of the testosterone is bound by this protein.

Comprehensive Health Evaluation: Rule out other potential causes of low testosterone, such as obesity, chronic illnesses, or medications. A physician will ask about your past medical history and see what impact genetics, age and other lifestyle choices may be having on your overall hormone health.

Management and Treatment of Subclinical Hypogonadism

Lifestyle Modifications to Help Treat Subclinical Hypogonadism

• Improve diet. Certain foods can help increase testosterone while others may have a negative impact.
• Increase physical activity. Exercise, specifically strength training have a measurable impact by increasing testosterone levels in men.
• Lose weight if overweight. Excess fat can increase estradiol levels and decrease testosterone levels which begins a cycle that can be difficult to break free from.
• Reduce stress. Increased stress and cortisol levels will cause a dramatic decrease in testosterone levels, so finding ways to limit stress from work, family, school, life, etc…will have a positive effect on health and wellness.
• Ensure adequate sleep. Studies have shown that even an extra hour of sleep will increase hormone production in men.

Monitoring:

• Regular monitoring of testosterone levels and symptoms to detect any progression to overt hypogonadism.
• Obtain baseline hormone readings and monitor them regularly. A simple blood test will help show any patterns and allow the physician to create an adequate protocol based on signs, symptoms and hormone levels.

Testosterone Replacement Therapy (TRT) for Relative Androgen Deficiency and Subclinical hypogonadism

• Generally reserved for those with significant symptoms impacting quality of life. An experienced physician can help test, diagnose, and treat men with an individualized protocol.
• Careful consideration of benefits and risks before starting TRT. During the consultation, a physician will go over what to expect and the right dose and careful monitoring should be able to help minimize the risks of and potential adverse side effects.
• Individualized approach based on symptom severity, lab results, and patient goals will help ensure that the maximum benefits of therapy and ensure patients safety and wellbeing.

Relative Androgen Deficiency

Relative androgen deficiency refers to lower-than-optimal levels of androgens for an individual’s age and physiological needs, but not necessarily a complete deficiency. This condition can occur in both men and women, though it is more commonly discussed in the context of aging men. Many patients remain undiagnosed because their testosterone levels are within normal ranges, though still suboptimal for their specific needs. A thirty-year-old male with testosterone levels in 300-400 range may be told that their levels are normal, but the symptoms that they are experiencing will usually only worsen with time and potentially lead to more serious health concerns.

Symptoms:

• Decreased libido/ low sex drive in men.
• Erectile dysfunction and lack of performance.
• Fatigue and tiredness. Low energy.
• Loss of muscle mass and decreased strength.
• Increased body fat especially around the stomach area.
• Decreased bone mineral density.
• Cognitive decline and brain fog.
• Mood changes and irritability.

Diagnosis:

Clinical Assessment: Evaluate symptoms through a comprehensive consultation with a healthcare provider who can prescribe testosterone. Its beneficial to seek guidance from a provider who is both knowledgeable and experienced in bio-identical hormone replacement therapy. Surprisingly, HRT is an area that often gets neglected during medical school and most physicians are working on outdated ideology and misinformation. Endocrinologists, urologists and hormone therapy specialists will have a better understanding of hos the body responds to treatment and what is appropriate for men looking to improve their health through TRT.

Blood Tests Needed to Start TRT: Measure both total testosterone and free testosterone levels (the bioavailable portion). Additional tests may include estradiol, PSA, CBC, Hematocrit, CMP, LH, FSH, and SHBG to provide a complete hormone profile. In some cases, an MRI may even be needed to look at pituitary function. Each person is unique and there is no one size fits all approach to medicine.

Consideration of Influencing Factors: Assess overall health, medications, lifestyle choices, and comorbid conditions that may affect testosterone levels. Age, genetics, medications, physical activity, work related stress can all contribute to poor endocrine functioning.

Management and Treatment:

Lifestyle Modifications:

• Improve diet. This can have a major impact on not just your hormones but all aspects of your overall health.
• Avoid drugs and alcohol. These will impact testosterone production and play a role in other contributing factors like sleep, stress and even impacting personal relationships which may cause a ripple effect throughout one’s life, including their capability to produce optimal levels of testosterone.
• Increase physical activity and exercise. For improving hormone levels weight training is particularly beneficial. Strength training has been proven to increase testosterone levels in men so regular exercise will have a positive impact.
• Reduce stress. Whether it’s from work, family, friends or just life in general, finding ways to reduce and deal with stress can greatly improve T production and improve overall quality of life and health.
• Ensure adequate sleep. Even one extra hour of sleep will allow the body to produce more testosterone. The male body produces the most testosterone during sleep which is why most blood tests are taken in the morning when levels are at their highest.

Address Underlying Conditions: Manage any health or medical conditions contributing to low testosterone levels. Diabetes and obesity are two such conditions which dramatically impact hormone levels.

Testosterone Replacement Therapy (TRT):

• Consider TRT for those with consistently low testosterone levels and significant symptoms.
• Monitor therapy closely due to potential risks and side effects associated with TRT. This is why a doctor who specializes in this field is important.
• Individualized treatment plans tailored to patient needs, with careful monitoring by an experienced healthcare provider.

Importance of Testosterone for Optimal Health

Both conditions highlight the crucial role of testosterone in maintaining optimal health in men. It’s also very important in women, but for the purposes of this article were focusing on the benefits for men with low T. Testosterone is vital for physical, emotional, and cognitive well-being. Its deficiency can lead to significant health issues, emphasizing the need for accurate diagnosis and personalized treatment from a doctor who specializes in this arena of medicine.

Subclinical hypogonadism often presents with subtle or no symptoms and requires careful monitoring and lifestyle changes, with TRT being a cautious approach. Relative androgen deficiency requires a more proactive assessment of individual needs, with TRT potentially considered earlier to improve quality of life despite normal reference ranges. Often you will see an older male on TRT who looks fit, happy and full of life with good muscle tone who is not just living longer as a result of optimized testosterone, but also enjoying a better quality of life as a result.

These conditions underscore the complexity of diagnosing and managing low testosterone levels and the necessity for more research to optimize treatment strategies. Personalized approaches are essential, highlighting the importance of a thorough diagnosis and tailored treatment plans to ensure the best health outcomes for patients.

To learn more about these conditions and potential treatments, visit NovaGenix or call/text us at (561) 277-8260 for expert guidance on hormone health and testosterone treatments. You can also email us with any questions to info@novagenix.org

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