One very common question that I get asked on the Peak Testosterone Forum is what tests should be done before going on HRT (TRT). Of course, the irony is that I did almost no testing before going on testosterone therapy. At the time I felt I was lucky to even get on HRT, much less get any kind of detailed evaluation beforehand. However, it is generally a good idea to run several common tests beforehand for severalcommon sense reasons:
Below is a list of the tests that I would request or do myself if I had it to do all over again. For those who don't know, you can pull many of your own tests if you live in the U.S. or other countries that have more medical freedom and I list them here on this page: Self-Testing Testosterone Labs.
1. Detailed Thyroid Exam. Not only does hypothyroidism produce symptoms similar to low testosterone, but it also lowers testosterone, something I cover in my page on Testosterone and the Thyroid. Furthermore, hypothyroidism is quite common and can take out the libido and erectile strength of even younger men. So this is a no-brainer in my opinion and should really be done, in my humble opinion, at every annual or well-being check (if a guy has hypothyroid symptoms of course). But, hey, no one asked me! The big problem is that money is so tight right now that physicians are reluctant to pull all the tests that you really need to check for hypothyroidism (TSH, T4, T3, free T4, free T3, rT3, antibodies, etc.).
2. Prolactin. One of the big mysteries in my mind is the fact that most physicians do not immediately pull prolactin when a man is diagnosed as hypogonadal. Elevated prolactin is a surprisingly common cause of low testosterone and, to get to the root, you've got to find the root cause, eh? I cover this issue in my page called Testosterone, Prolactin and Prolactinomas. And some of the symptoms overlap with classic hypogonadism, especially lowered libido. This is an obvious case, where if you don't correct the underlying problem, you are really swimming upstream.
3. Zinc Deficiency. Although I have seen this only once on the forum, correcting a deficiency in this all important nutrient and mineral can lead to tremendous increases in testosterone, something I cover in detail in my page Testosterone and a Zinc Deficiency. How do you know if you are deficient? I plan on doing a page on this soon, but one fairly common way now is to use one of the "Zinc Taste Tests" out there.
4. Varicocele. Varicoceles are very common and are essentially a cluster of varicose veins that affect the testicle(s). They can, among other things, lower testosterone. Correcting a varicocele is done through a relatively simple urological procedure, but, of course, discuss risks and rewards with your doc. Men on the Peak Testosterone Forum have reported just plain feeling better after the procedure, improved sleep and increased testosterone. See my page on Varicoceles and Testosterone for more information.
5. Sleep Disorders. Does your wife or girlfriend insist that you snore? Do you have restless legs at night or wake up gasping for air? Or are you just depriving yourself of sleep? If so, a significant body of research shows that you could be lowering your testosterone and raising your insulin and inflammation. See my pages Sleep and Testosterone and Apnea and Testosterone for more information. There are apps for your phone and oximeters that you can do at home to give you a rough idea, but the gold standard is a sleep study. Often insurance will pay for it.
6. Depression. Depression effects everything. Researchers have recently found that the end result of depression - and possibly a partial cause - is large scale brain inflammation, obviously not a good thing. And, as one might expect, depression can lower your testosterone levels (and vice versa). See my page on Testosterone and Depression.
7. High or Low Cortisol. Of course, stress in modern life is inevitable. Can you say career, mortgages, relationships, sick family members and car problems?. Some men walk around in a constant state of anxiety almost full time. And many men fall into ruminative (repeating the same thing over and over) thinking. All of these can raise levels of cortisol and other stress hormones such as adrenaline and noradrenaline. Cortisol can also dampen serotonin, which only makes matters worse. And the stress hormone noradrenaline literally puts the brakes on erections, so that you don't battle priapism. However, too much can keep you from a decent erection at any time.
Lifestyle issues can contribute to problems as well. For example, many men do not realize that low carb diets work by raising stress hormone levels. Some guys can handle the elevated stress hormone levels than others. Infections, overtraining and illness can also do it. For natural ways to handle this, see my Summary Page on Stress and Cortisol Management. Is it important also to monitor yourself and the typical way to do that is with a 3 or 4 point cortisol test, i.e. take your cortisol reads at 3-4 different times of the day. If your doc will not test you, you can do it at my of these Testosterone Labs.
8. Overtraining. Unfortunately, a big percentage of guys that exercise overtrain. In fact, this is the only way they know how to train. I remember one guy I met who despised the word "jogging." He said, "I run. I don't jog." And how many guys go into a gym and throw on 20 more pounds than they can really lift? Added to that is the fact that we are taught to ignore pain and many of the workout videos emphasize very brutal workouts. The end of the story is that many guys drive themselves into a hormonal ditch. You can only whip a horse so long before it gives out. There are many signs of overtraining and things like recovery pulses, disturbed sleep, mental fog, frequent upper respiratory infections, etc. Of course, the solution is moderate exercise with a lower pulse rate until you are completely recovered.
9. PSA. The PSA test is controversial and that is because it can increase from prostate cancer, prostatitis / inflammation and also BPH (enlarged prostate). In my opinion, it is still a valuable test and most endocrinological guidelines insist that a PSA be taken and monitored for men on HRT (TRT). When you go on HRT, your prostate size will increase a little (due to the increased DHT) and thus your PSA may rise a little. However, this change is usually small. Because the PSA test is now so cheap, I think it's a good idea to pull it before and after.
9. DHEA. HRT (TRT) can lower DHEA in some men and so I think it is a good idea to take a read before you start HRT beforehand so that you can monitor the actual change that occurred.
MISCELLANEOUS TESTS: Other tests of interest could be DHT, SHBG, estradiol, blood pressure, PSA and hematocrit / hemoglobin. These are all effected by testosterone and so it's nice to know the net change that is produced oftentimes.
NOTE: There are also some rather major reasons - things like genetic disorders as an example - for hypogonadism and I cover those in my page Major Causes for Low Testosterone. You might also browse through those and discuss with your physician if appropriate.