From the Guidelines
Men with diabetes should consider checking their testosterone levels if they experience symptoms of hypogonadism, such as decreased sexual desire or activity, or erectile dysfunction, as recommended by the most recent guidelines 1. The best approach to checking testosterone levels is to do so in the morning, when testosterone levels are naturally highest, using an accurate and reliable assay. Some key points to consider when checking testosterone levels include:
- Testing should be considered for men with symptoms of hypogonadism, such as decreased libido or erectile dysfunction 1.
- The best time to test is in the morning, between 7-10 AM, when testosterone levels are naturally highest.
- Testing involves a simple blood draw measuring total testosterone, and sometimes free testosterone and other hormones like luteinizing hormone and estradiol.
- Low testosterone can significantly impact quality of life, so it's essential to discuss symptoms with a doctor, who can order appropriate tests and interpret results in the context of overall health 1. It's also important to note that obesity is a major confounder of low testosterone levels in men with diabetes, and treatment in asymptomatic men is controversial 1. However, testosterone replacement in men with symptomatic hypogonadism may have benefits, including improved sexual function, well-being, muscle mass and strength, and bone density 1. Regular monitoring every 3-6 months is necessary for men on testosterone replacement therapy to ensure proper dosing. Overall, the decision to check testosterone levels should be based on the presence of symptoms and a discussion with a healthcare provider, taking into account the potential benefits and risks of testing and treatment 1.
From the FDA Drug Label
Prior to initiating testosterone cypionate, confirm the diagnosis of hypogonadism by ensuring that serum testosterone concentrations have been measured in the morning on at least two separate days and that these serum testosterone concentrations are below the normal range.
You should check your testosterone levels in the morning on at least two separate days to confirm the diagnosis of hypogonadism before initiating testosterone cypionate treatment 2.
From the Research
When to Check Testosterone Levels
- Testosterone levels should be checked in men with symptoms of hypogonadism, such as decreased libido, erectile dysfunction, and infertility 3, 4, 5.
- However, symptoms commonly attributed to testosterone deficiency, such as fatigue and depression, may not be associated with low total testosterone levels 6.
- Men with comorbid conditions, such as osteoporosis, prostate cancer, and hypertension, are more likely to undergo testosterone testing 4.
- The frequency of testing for low testosterone has increased over the years, with most testing practices directed toward a subset of men with comorbidities associated with hypogonadism 4.
Importance of Morning Testosterone Levels
- Morning testosterone levels are considered the most accurate, as testosterone levels naturally fluctuate throughout the day 4.
- However, compliance with obtaining early morning serum testosterone levels is low, with only 9% of men undergoing testing between 7 am and 12 pm 4.
Relationship Between Testosterone and Sexual Function
- Low testosterone levels have been associated with erectile dysfunction and decreased libido 3, 5.
- Testosterone replacement therapy (TRT) has been shown to improve sexual activity, hypogonadal symptoms, and sexual desire in men with hypogonadism 7.
- However, TRT may not improve erectile function in all men, and its effects on sexual function may vary depending on individual circumstances 7.