Comparing and Contrasting Relative Androgen Deficiency and Subclinical Hypogonadism
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
ü Improve diet. Certain
foods can help increase testosterone while others may have a negative impact.
ü Increase physical
activity. Exercise, specifically strength training have a measurable impact by
increasing testosterone levels in men.
ü 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.
ü 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.
ü Ensure adequate sleep.
Studies have shown that even an extra hour of sleep will increase hormone
production in men.
Monitoring:
ü Regular monitoring of
testosterone levels and symptoms to detect any progression to overt
hypogonadism.
ü 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
ü 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.
ü 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.
ü 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:
ü Improve diet. This can have a major
impact on not just your hormones but all aspects of your overall health.
ü 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.
ü 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.
ü 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.
ü 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):
ü Consider TRT for those
with consistently low testosterone levels and significant symptoms.
ü 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.
ü 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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