Complaints & connections · borters.ch
A single value settles nothing — measured in the morning, twice, with SHBG. And the cause is often correctable before hormones are given.
Also known as: testosterone deficiency · male hypogonadism
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A testosterone deficiency is not settled by the value alone but by symptoms together with a repeatedly low value. That is the most important sentence on the subject, because a single measurement says little: testosterone follows a daily rhythm, is highest in the morning and falls temporarily with every infection, with lack of sleep and under strain. It is therefore measured fasting between seven and eleven in the morning, and a low value is confirmed on a second day. The SHBG, the transport protein, belongs with it: low with overweight, high with age and liver disease — both shift the total value without much changing the effective part. Once the shortage is confirmed, the real question is why. LH and FSH separate the two routes: if they are high it is the testicle itself; if they are low or normal it is the control in the head — and behind that often stand things that can be put right: marked overweight, untreated sleep apnoea, opioids, cortisone, a raised prolactin, more rarely iron overload. If the cause is tackled, the value often rises again by itself. Taking testosterone, by contrast, switches off one’s own production — and with it fertility.
Fasting between seven and eleven, on two different days, not during an infection. That one rule prevents most misdiagnoses in both directions.
Only with the SHBG can the total value be translated. With overweight or older age the free or calculated share decides, not the total number.
Anyone who snores loudly, falls asleep in the day and has pauses in breathing usually gains more from treating that than from a hormone — and on several fronts at once.
The most effective lever in the commonest form. Fat tissue converts testosterone; less of it and more muscle shift the value measurably upwards.
Opioids, cortisone, some antidepressants and anabolic steroids act directly on the control. That belongs at the start of the workup, not at the end.
Iron is laid down in the pituitary too. A low testosterone together with joint pain, tiredness and raised liver values is a known combination.
Testosterone as gel or injection replaces what is missing — drive, muscle and bone density respond over weeks to months. The body’s own production shuts down and fertility falls: anyone still wanting children takes a different route. That is the key piece of information before the first injection.
It is measured in the morning between seven and ten, because the value falls by up to thirty per cent across the day — and at least twice on different days, because a single value varies strongly. From about forty the level falls by one to two per cent a year; that alone is not an illness. On treatment, drive and mood improve over three to six weeks, muscle and bone density over six to twelve months. Sperm production falls within weeks.
Fading morning erections are one of the few reasonably specific signs. Tiredness and low mood alone have very many other reasons.
The link runs both ways: belly fat lowers testosterone, and low testosterone encourages belly fat. Which is why losing weight often breaks the circle.
Untreated sleep apnoea reliably lowers testosterone. Treating it often works better here than any hormone preparation.
Opioids strongly damp the control and are almost never recognised as the cause. The same goes for longer courses of cortisone and for anabolic steroids from the gym.
That changes everything. Testosterone from outside switches off one’s own production and sperm formation — where children are wanted there are other routes, and they belong discussed beforehand.
Fasting between seven and eleven, and a low value is confirmed on a second day. Measured in the afternoon, after a bad night or during an infection the value is not usable.
The transport protein. Without it a total value cannot be placed: with overweight the SHBG is low and the total therefore seems too low, with age it is high and the value seems too good.
These two separate the cause. High means the testicle itself. Low or normal means the control in the head — and that is where the correctable reasons usually lie.
A raised prolactin damps the control and has a cause of its own, often well treatable. It belongs to the first workup when LH and FSH are not raised.
With a proven zinc deficiency testosterone rises again after correction; without deficiency zinc changes nothing. Oysters, beef, pumpkin seeds and oats are the densest sources.
Fat tissue holds aromatase, which turns testosterone into oestradiol. Losing 5–10 % of body weight raises the level measurably in studies — over months, not weeks.
Strength training measurably raises the level — and works on everything the deficiency affects.