August 8, 2023, 9:25 am | Read time: 8 minutes

Men who wonder if their hormone status is in order should first be reassured: The typical testosterone deficiency patient is over 50, significantly overweight, and does not exercise. Among those over 50, only two percent have a true testosterone deficiency syndrome, and among those over 70, it’s five percent. So, it’s not many. Nevertheless, there are, of course, legitimate reasons to have a hormone test done—and definitely by a doctor. Symptoms include sexual dysfunction with reduced libido, altered metabolism, and lack of drive (FITBOOK reports more extensively here on the signs of testosterone deficiency). If men notice symptoms in themselves, it may be worth checking their hormone levels. To avoid unnecessarily spending a lot of money on extensive lab tests and to have meaningful results in hand, there are a few details to keep in mind. The optimal hormone test for men: FITBOOK spoke with urologist Dr. Christian Leiber-Caspers, head of the andrology department at Alexianer Hospital Krefeld.

Blood Draw in the Afternoon Not Very Useful

How important is a double determination?
Leiber-Caspers: “A double determination is always required for a lab test on which a diagnosis depends. This is because testosterone levels fluctuate even in healthy men. For example, if I run a half marathon today and go to the doctor the next day to have blood drawn, two measurements are always necessary.”

How far apart should these two measurements be?
Leiber-Caspers: “One measurement should ideally be done in the morning. If athletic performances are involved, you should wait two weeks for the second measurement. Important: Have the control measurement done in the same lab! Labs purchase different equipment, so consistency is key.”

Also interesting: Can Testosterone Deficiency Trigger Serious Illnesses?

Hormone Test for Men: Interpretation Pitfalls in Lab Evaluation

The lab has sent the evaluation of the hormone test. What should you definitely pay attention to now?
Leiber-Caspers: “Labs in Germany are of a good standard. However, if you, as a layperson, hold a test result in your hand, you must know that labs measure with different methods and units. This means the unit of measurement for testosterone can vary. Many labs measure in nanograms per milliliter (ng/mL, editor’s note). However, I am used to measuring in nanomoles per liter (nmol/L, editor’s note). You can convert this, but it’s not really something for laypeople or patients.”

Normal reference ranges are given on the lab evaluation. What should you know about this?
Leiber-Caspers: “If you were to inquire, you would find that this normal range is sometimes based on a population of 20 or 30 patients. Very questionable from a scientific point of view, because to be meaningful, you would need hundreds or thousands. Therefore, it is difficult to compare your own value with the normal value. If you are above or below it, you might think you have a pathologically abnormal value—which is not true. So: Be very careful when comparing your values with any norm or standard values.”

So I can’t avoid seeing a doctor for the interpretation of a hormone test …
Leiber-Caspers: “Yes. Please be sure to see a specialist—an endocrinologist or urologist, preferably with the additional qualification in andrology. These doctors specifically deal with this topic, and the correct interpretation of these values is not always easy.”

Also interesting: Boost Testosterone Naturally – Methods and Strategies at a Glance

This Value Matters When Suspecting Testosterone Deficiency

Which value(s) should be measured?
Leiber-Caspers: “In case of suspected testosterone deficiency, I would first determine only the total testosterone. This important value is quite stable, meaning the blood sample does not need to go to the lab immediately after collection (doctors usually no longer have their own labs), it can also be sent to a lab that is 100 kilometers away one or two days later. If the measured total testosterone value is normal, no further determinations need to be made.”

And if the result is negative?
Leiber-Caspers: “Then, in some cases, you also need the free testosterone. However, measuring this very small portion of total testosterone, which is only 3 to 5 percent, is much more delicate because it is absolutely unstable. It can only be reasonably determined if I take your blood and run directly to the lab with the sample—which is practically impossible anywhere. Therefore, a measurement of free testosterone is generally not feasible.”

The guidelines recommend determining free testosterone through a calculation …
Leiber-Caspers: “Exactly. You need the two stable main binding proteins: albumin and SHBG, the sex hormone-binding globulin. There are calculators¹ online that allow you to calculate the free testosterone level with these two values and the total testosterone. The results correlate quite well with measurements made under scientific conditions.”

What a High LH Value Indicates

What about measuring the stimulating hormones LH and FSH?
Leiber-Caspers: “Testosterone production, like many hormones, depends on a stimulating hormone. In men, it is LH, luteinizing hormone. Actually, a misleading term because it only exists in women as part of the cycle. Men don’t have a luteal phase; however, the hormone interestingly looks 100 percent identical to LH in women, which is why the term was adopted. It should actually be called testosterone-stimulating hormone. A high LH value typically indicates a disturbance in testosterone production. This is the case, for example, with congenital small testes. This is the primary form of testosterone deficiency. In the secondary form, the higher-level control of hormone production does not work: for example, there is a problem with the pituitary gland. In this case, the stimulating hormones LH and FSH (follicle-stimulating hormone for sperm formation) are low.”

Also interesting: Low-Fat Diet Significantly Reduces Testosterone Levels in Men

When Health Insurance Covers Hormone Tests for Men

That brings us to the question of when health insurance covers a hormone test for men?
Leiber-Caspers: “If there is a medical indication, meaning the doctor has identified corresponding symptoms of testosterone deficiency, it is a medical insurance benefit. The typical testosterone deficiency patient is over 50, significantly overweight, and does not exercise. If such symptoms are present, it is an insurance-covered medical service.”

Decreased Muscle Strength as a Possible Sign of Testosterone Deficiency

What symptoms are we talking about?
Leiber-Caspers: “Men with clinical signs of testosterone deficiency such as reduced libido, decreased performance, concentration problems, decreased drive, and reduced muscle strength, who also do little exercise and are significantly overweight, have a statistically higher risk of having testosterone deficiency syndrome. Ultimately, however, the suspected diagnosis should be made by a doctor if it is a medical indication.”

And if ‘Mr. Smith’ wants to interpret a hormone test himself …
Leiber-Caspers: “Then it is an individual health service, and ‘Mr. Smith’ has to pay for the hormone test himself. The hormone value determinations all cost about the same, you have to calculate 25 to 30 euros per determination. If you have total testosterone, albumin, SHBG, and LH tested, you have to pay for the hormone test yourself. The hormone value determinations all cost about the same, you have to calculate 25 to 30 euros per determination. If you have total testosterone, albumin, SHBG, and LH tested, you have to calculate about 100 to 120 euros. But: If the measured total testosterone is too low, the health insurance will cover the costs for the other tests.”

Also interesting: What Are Hormones and How Do They Work?

Not Every Man Over 50 Needs Testosterone, That’s Complete Nonsense

Why do you think doctors are hesitant about hormone tests for men?
Leiber-Caspers: “In my opinion, it’s because testosterone is also used illicitly. Keyword: doping. This criminal area leads to testosterone having a bad reputation. According to current guidelines², only two percent of those over 50 have a true testosterone deficiency syndrome, and five percent of those over 70. That’s not many. Not every man over 50 needs testosterone—that’s complete nonsense.”

More on the topic

Consulting the Urologist 7 Signals for Men Over 40 to Check Their Testosterone Levels

FITBOOK Makes the Comparison Blood, Hair–These Vitamin Self-Tests Are Useless

Testosterone Saliva Tests? You Can Save Your Money

Are testosterone saliva tests from the pharmacy any good?
Leiber-Caspers: “You can save your money because they measure all sorts of things, but not the correct testosterone level. Saliva tests are not well validated from a scientific perspective. So, we don’t know how well or poorly they measure compared to blood values. Therefore, I strongly advise against them, as recommended in the current guidelines of the European Association of Urology².”

Sources

• 1. Hormonspezialisten.de: Free Testosterone Calculator (accessed on 08/07/2023)
• 2. European Association of Urology (accessed on 07/08/2023)