From the Guidelines
Yes, offering a blood test to check hormone levels, specifically testosterone, can be beneficial in many situations, particularly when patients exhibit symptoms of hypogonadism or have a history of certain medical conditions. When considering a blood test for hormone levels, it's essential to evaluate the patient's symptoms and medical history. According to the American Urological Association guideline 1, the diagnosis of testosterone deficiency requires both a low testosterone measurement and the presence of select symptoms and/or signs. The guideline recommends measuring total testosterone in patients with a history of unexplained anemia, 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 in the absence of symptoms or signs associated with testosterone deficiency. Some key points to consider when evaluating patients for testosterone deficiency include:
- Measuring total testosterone levels below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone 1
- Conducting two total testosterone measurements on separate occasions, both in an early morning fashion, to confirm the diagnosis 1
- Evaluating patients for symptoms associated with low testosterone, such as reduced energy, reduced endurance, diminished work and/or physical performance, fatigue, visual field changes, anosmia, depression, reduced motivation, poor concentration, impaired memory, irritability, infertility, reduced sex drive, and changes in erectile function 1
- Conducting a targeted physical exam to examine patients for signs associated with low testosterone, including evaluation of general body habitus, virilization status, body mass index or waist circumference, gynecomastia, testicular evaluation, varicocele presence, and prostate size and morphology 1 The most appropriate blood test to offer would be a total testosterone level, preferably measured in the morning when levels are most stable, and potentially followed by additional tests such as luteinizing hormone and follicle-stimulating hormone levels to determine the etiology of testosterone deficiency 1. It's also important to consider the patient's overall health and medical history, as well as the potential risks and benefits of testosterone replacement therapy, particularly in older men with hypogonadism, who may be at increased risk for cardiovascular events 1. Ultimately, consulting with a healthcare provider is the best first step to determine which specific tests are most relevant for the patient's situation and to develop an individualized treatment plan.
From the Research
Blood Test for Hormone Levels
To determine if a blood test should be offered to check hormone levels, several studies provide relevant information.
- The study 2 suggests that total testosterone was the most frequently abnormal biochemical marker for polycystic ovary syndrome (PCOS), and that testosterone, androstenedione, or luteinizing hormone (LH) should be the definitive hormonal tests.
- Another study 3 found significant increases in hormone levels, including LH and follicle-stimulating hormone (FSH), in women with PCOS compared to a control group.
- A study 4 evaluated the therapeutic effect of metformin on clinical features, hormonal, and metabolic profiles in obese women with hyperinsulinemic PCOS, and found that metformin treatment improved menstrual patterns and decreased testosterone levels.
- The study 5 assessed the diagnostic performance of anti-Müllerian hormone, LH to FSH ratio, testosterone, and prolactin to predict PCOS, and found that anti-Müllerian hormone had the largest operating characteristic curve and good diagnostic potency for the diagnosis of PCOS.
Recommended Blood Tests
Based on the studies, the following blood tests may be recommended to check hormone levels:
- Total testosterone
- Androstenedione
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Anti-Müllerian hormone
- Prolactin
Considerations
It is essential to note that the normal range for all hormones should be precisely defined in a group of regularly ovulating women in the early follicular phase of the cycle for the assay used in each laboratory, as stated in the study 2. Additionally, the study 6 highlights the importance of establishing norms of LH and FSH response to a standard dose of LH-RH in evaluating normal and abnormal pubertal states in both sexes.