In their inaugural episode, join the Curbsiders as they tackle the hot topic of Low Testosterone by curbsiding with Endocrinologist Dr. Jeff Colburn, a leading clinician and educator in San Antonio, Texas.
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Usually wife complains of husband with low libio and poor sexual function. Other non-specific symptoms include depressed mood, loss of bone and lean muscle mass, weight gain and fatigue.
Look for gynecomastia and testicular atrophy (less than 20-30 cc and soft consistency)
Step 1) Check total testosterone (total T) between 7am and 10am. Testosterone is 60% bound to sex hormone binding globulin (SHBG), 39% albumin bound and 1% free testosterone.
Step 2) If total T is less than 300, then repeat total T but add FSH, LH, prolactin, SHBG and bioavailable testosterone.
Step 3) Consider MRI if prolactin high or if low testosterone in a young male
Note: Obese males have low sex hormone binding globulin. This creates an artifact of low Total T (since 60% is bound to SHBG). Therefore, do not treat these patients unless they have low bioavailable testosterone.
Trial of topical therapy recommended. Apply in AM to mimic physiologic levels. Start at 40 mg. Consider repeat level in 2-4 weeks. Goal is Total T 400 to 700 and monitor for improved mood, energy and libido. If no improvement then stop therapy.
Note: Some patients may ask but use is not recommended in women.
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