Written by Leann Poston, M.D.
Two of the most common questions on the testosterone forum on Reddit are how to interpret testosterone labs and where to get online testosterone replacement therapy (TRT). Testosterone testing and prescriptions have nearly tripled in recent years. There are also many men using TRT without receiving proper testing and guidance. Studies show that up to 25% of men do not have their testosterone levels tested prior to starting TRT. On the other hand, a large percentage of men would benefit from TRT and are not receiving it (Mulhall et al., 2018).
The Endocrine Society has guidelines for testosterone and testosterone replacement. Their overarching guidelines are that testosterone replacement therapy should only be started in men with low testosterone levels, symptoms correlated with those levels, and no contraindications to starting testosterone therapy. The testosterone forum on Reddit asks users before posting to confirm whether they have had blood work. Blood work is essential before considering online TRT.
Testosterone levels are required to determine whether testosterone replacement is likely to have any beneficial effect. A symptom profile is necessary to complete a risk versus benefits analysis. All medications have side effects. If the symptoms suggest testosterone deficiency and the benefits of testosterone replacement therapy (TRT) outweigh the risks, then it is appropriate to begin replacement therapy. Contraindications for testosterone therapy need to be evaluated as patients with contraindications will have significantly more risk if therapy were to be started than those without these risks. For example, blood hematocrit should be checked as testosterone replacement can further increase the number of red blood cells, increasing the potential for blood clots. Each man has a different risk versus benefits profile. This is why it is so important that men choose online TRT from clinics that require testing prior to TRT.
Symptoms of low testosterone may include the following:
Looking through the Reddit forum, most men reported low libido, decreased energy, depression, and weight gain as common symptoms that led them to consider online TRT.
Testosterone levels fluctuate throughout the day and night. Levels are usually highest in the morning. Endocrinologists suggest two separate measurements of total testosterone in the morning (between 8 am and 10 am) using the same laboratory. Those with borderline total testosterone levels may need additional labs (Bhasin et al., 2010). The American Urological Society recommends using a total testosterone level below 300 ng/dl as a cut-off to support starting TRT (Mulhall et al., 2018). On Reddit, users recommend that blood work be obtained first and then discussed with a doctor before posting lab work and asking questions about online TRT. They suggest that all lab values include reference ranges, noting the importance of identifying the normal values in individual labs.
Total testosterone levels should be measured in men with a history of unexplained anemia (low red blood cells), bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even if these men have no symptoms of low testosterone (Mulhall et al., 2018). Total testosterone levels have a lower sensitivity in men aged 50 and older. Free testosterone levels are preferred in these men (Merck Manual, 2019).
Testosterone can be in three forms in the blood: bound to sex hormone-binding globulin, bound to albumin, or free in the bloodstream. Only the testosterone bound to albumin and free in the bloodstream is biologically active. Free testosterone levels should be calculated or measured using equilibrium dialysis. The reference range used to evaluate testosterone levels should be both age and assay-specific. Many men on Reddit mention the need to check that lab values are properly obtained and referenced before considering online TRT.
The pituitary gland secretes luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH stimulates the production of testosterone in the testes. Measuring LH levels can help determine whether the cause of low testosterone levels is coming from the pituitary gland or the testes. Those with low testosterone levels and low LH levels may be candidates for selective estrogen receptor modulator use (Mulhall et al., 2018).
Selective receptor modulators have been used in men who have low testosterone levels and want to maintain their fertility. Clomid and tamoxifen are two selective estrogen receptor modulators that have been used in men with low testosterone levels or to correct an imbalance between testosterone and estradiol.
Aromatase inhibitors can also be used in men who have an imbalance between testosterone levels and estradiol. Elevated estradiol levels may cause gynecomastia or increased breast tissue in men. Estradiol levels may increase when men are started on TRT. Symptoms from gynecomastia or other breast-related symptoms are not considered normal and should be investigated (Mulhall et al., 2018). Aromatase inhibitors lower estrogen by blocking the enzyme that converts testosterone to estrogen (Rambhatla et al., 2016).
Prolactin is a hormone that stimulates breast development and milk production in the female. Increased levels in a male may indicate that the cause of low testosterone levels is coming from the pituitary gland. Since LH also comes from the pituitary gland, the American Urological Association recommends getting prolactin levels on all men with low testosterone levels and low or low to normal LH levels.
|Lab Values||Age Range||Reference|
|Total testosterone levels||19 years and older||240-950 ng/dl|
|Free testosterone level||20-<25 years: |
|Testosterone bioavailable||20-29 years: |
|Luteinizing hormone (LH)||Males over age 18||1.3-9.6 IU/L|
|Albumin Levels||Over 12 months||3.5-5.0 g/dL|
|Sex Hormone Binding Globulin||Males over age 18||10-57 nmol/L|
PSA test: A prostate-specific antigen test should be obtained in men older than age 40 prior to starting testosterone replacement therapy (TRT). A PSA test is a screening test for disorders of the prostate, including prostate cancer. A screening PSA test is intended to identify men with prostate cancer that have not yet presented with any signs or symptoms of the disease (Mulhall et al., 2018).
HbA1c: A HbA1c is a screening test for diabetes. Symptoms of diabetes include increased thirst, increased urination, and increased hunger with unintentional weight loss.
DEXA Scan: A DEXA scan is used to measure bone density and is recommended for men who have a history of low trauma bone fractures.
Hemoglobin and hematocrit levels: Increased numbers of red blood cells can be a side-effect of testosterone therapy. Before starting testosterone replacement therapy, all men should have baseline hemoglobin and hematocrit level (Mulhall et al., 2018).
On the testosterone forum on Reddit, a second hot topic discusses where to obtain online TRT if lab values indicate that testosterone replacement is an option.
Reddit users have many threads discussing online TRT clinics and pharmacies. Many of the threads note the following should be considered when choosing an online TRT clinic:
Many men consult online forums such as Reddit to benefit from the experience of others when determining how to go about choosing an online clinic for TRT. Invigor Medical is an online full-service telemedicine clinic staffed by licensed, board-certified physicians in your state. Invigor Medicine works with Olympia Compounding Pharmacy, a licensed, U.S. based pharmacy.
Physicians associated with Invigor Medical follow the protocols endorsed by the American Urological Association. A complete blood panel is ordered to evaluate your hormone levels. These blood levels are evaluated along with your current symptoms to determine the risk versus benefits of prescribing TRT through the online clinic. During your consultation with the telemedicine provider, contraindications to testosterone replacement therapy (TRT) will be discussed. If you and your physician agree that TRT is a good option for you, a prescription will be transmitted to Olympia Pharmacy, and the medication and supplies will be sent to your home.
To learn more about Invigor Medical, navigate to https://invigormedical.com/
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
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