Evaluating Hormone Levels for Testosterone Pellet Therapy

Evaluating hormone levels for testosterone pellet therapy is critical when determining whether you are a good candidate for undergoing testosterone pellet therapy and guiding your dosing. Three routes are currently available for hormone level evaluation: blood, saliva, and urine. The blood test is the definitive test for assessing hormone levels at a specific time. The advantage of blood values is that you can assess both the free or active form of the hormone and the total hormone, comprised of the free and bound forms. 

Hormones bound to carrier proteins will give you a total value for the particular hormone but also contain a portion of the hormone that is not active. The acknowledgment that some hormones fluctuate throughout the day makes blood test values potentially inadequate. For example, the stress hormone cortisol is quite variable throughout the day and typically demonstrates a diurnal cycle with peaks occurring twice a day in the morning and evening.

In contrast, saliva and urine provide a more prolonged picture of your hormone levels. Salivary samples can be collected multiple times during the day. The advantage of obtaining salivary samples is that it is easy to collect. The disadvantage of salivary samples is that the hormones in their free fraction form can vary in value throughout the day. Since you typically deposit your saliva four times throughout the day, you may still misspeak or troughs throughout the day. 

The advantage of urine collection is that it will provide a complete evaluation of a 24-hour hormone level, as the 24-hour urine collection requires you to collect all of your urine samples throughout the day. The disadvantage of urine hormone evaluation is that it only measures the free hormone values as the protein-bound hormones are preserved in the blood and not urinated. 

Collecting your urine for the entire day may also be cumbersome, especially if you have to be at work. 24-hour urine hormone tests are excellent for evaluating growth hormone, triiodothyronine thyroxine, Cortisol, DHEA, Aldosterone, Estradiol, and Testosterone. 

Suppose you are interested in getting testosterone pellet therapy. In that case, you will require an initial slate of tests that include: Free Testosterone, Total Testosterone, Thyroid (T3), Free Thyroid (T4), sex hormone binding globulin, Thyroid peroxidase (TPO), CBC, Prostate-specific antigen (PSA), and CMP.

TestNormal Values
Free TestosteroneMales: 300 – 1000 ng/dl or 10 to 35 nm/L Females: 15 to 70 ng/dL or 0.5 to 2.4 nmol/L
Total TestosteroneMales: 270 to 1070 ng/dL Females: 15 to 79 ng/dL
Sex Hormone Binding GlobulinMales: 10 – 57 nmol/L Females: 18 to 144 nmol/L
Thyroid (T3)60 – 180 ng/dL or 0.9 – 2.8 nmol/L
Free Thyroid (T4)0.9 – 2.3 ng/dL or 12 – 30 pmol/L
Thyroid Peroxidase (TPO)<9 IU/ml
Prostate Specific Antigen (PSA)0 – 2.5 ng/ml
CBCHb: Females 11.6 – 15 g/dL        Males: 13.2 – 16.6 g/dL WBC: 5 – 10 x 109 cells / L
Complete Metabolic Panel (CMP)Albumin 3.4 – 5.4 g/dL (34 to 54 g/L) Alkaline Phosphatase  20 – 130 U/L ALT: 4 – 36 U/L AST: 8 – 33 U/L GFR: 90 – 120 mL/min/1.73m2

Free testosterone is the best predictor of the amount of testosterone that is functional. Only free testosterone can interact with other cells and receptors in the body. This is in contrast to total testosterone, which conveys the amount of testosterone available but is not necessarily functional. Total testosterone describes the total amount of free testosterone bound up by sex hormone-binding globulin (SHBG).

If your SHBG is high, you may have low-functioning testosterone even if your total testosterone is high. Interestingly, only 1 to 2% of your testosterone is free, yet 80% is bound to SHBG, and a smaller percentage is bound to albumin. Thyroid levels are checked to ensure that your low testosterone symptoms are not due to a low thyroid level. In addition, high thyroid levels may be falsely elevating your testosterone levels.

In summary, your thyroid hormones affect all of your hormones in addition to testosterone. T3 and T4 are evaluated to get a comprehensive evaluation of the functional status of your thyroid gland. If your thyroid levels are abnormal, thyroid peroxidase can be ordered to diagnose the cause of your thyroid abnormality. If your TPO is high, you may have an autoimmune condition that suppresses or excites your thyroid cells.

The prostate-specific antigen is a laboratory test used to monitor males for prostate cancer. Since testosterone has been associated with increased prostate cancer risk, all men considering testosterone replacement therapy must undergo a PSA check to ensure that their prostate functions normally. A complete blood count or CBC is used to check for two important markers before getting testosterone pellet therapy. First, since pellets will be implanted, it is important to ensure that you don’t have an active infection. The white blood count or WBC can rule out an active infection.

The second factor is your hemoglobin. Previous reports have established an increased risk of heart attacks if your blood count or hemoglobin is elevated. Testosterone may elevate your hemoglobin levels, thus making it necessary to evaluate your hemoglobin levels initially and monitor them during your treatment. A complete Metabolic panel or CMP is important to determine the capacity of your body to metabolize toxins and hormones. The CMP will determine your liver and kidney’s ability to metabolize products, thus affecting the dosing of your testosterone therapy.

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