Early warning indicators of male hormone health risks

For men aged 18-65, the three core warning indicators of hormonal health risks that deserve the most priority are morning fasting total testosterone level <12 nmol/L, free testosterone index (FTI) <2%, and luteinizing hormone (LH)/total testosterone ratio >0.3. As long as any one of these indicators appears, priority should be given to investigating potential reproductive, metabolic or endocrine pathologies without waiting for all the so-called "typical symptoms" to appear.

Don’t think this is alarmist. Last week, a 32-year-old Internet operator came into my clinic. He stayed up until two o’clock every day to focus on the project. When he came in, he said that he had gained 20 pounds in the past six months and was not interested in anything. He couldn’t even call him on weekends after playing basketball for ten years. His girlfriend thought that he was not in the relationship and wanted to break up. He also felt that he was tired from working overtime and that he could recover after a couple of days of sleep. The blood test showed that the total testosterone was only 8.7nmol/L, which is nearly 1/4 lower than the lower limit of the reference interval given by most hospitals, and the free testosterone index was only 1.2%. It is a typical early stage of hypogonadism. If it takes another year and a half, it is likely to affect the quality of sperm and even induce abnormal fluctuations in blood lipids and blood sugar.

When it comes to this, we have to mention two different judgment logics in the industry. Many andrology clinicians prefer "symptoms first" - after all, if there are no clear problems such as obvious functional decline, bone loss, and persistent fatigue, even if the indicators are slightly low, they will not rush to take medication. At most, they will let you adjust your work and rest, supplement some nutrients, and observe； However, most colleagues in the endocrinology department believe in "pre-indexing", especially for people over 40 years old who also have hyperlipidemia and diabetes. Subclinical testosterone deficiency will in turn increase the metabolic burden, and it will take several times more effort to adjust after symptoms appear. Both statements are actually correct, but they are applicable to different groups of people. Young people have strong metabolic abilities, and their indicators may be low for a year or two before symptoms appear. Middle-aged and elderly people have underlying diseases, and their physical symptoms are obvious after a slight injury.

Don’t think that you have to draw blood and go to the hospital to check your hormones. Many daily signals are the most intuitive warnings. For example, if you rarely have spontaneous erections in the morning for two or three months in a row, don't use "too tired recently" as an excuse. If this problem occurs in a young man in his 20s, it is most likely that the testosterone level has quietly dropped. There are also those who haven’t eaten and drank in half a year, and have gained almost 10 pounds out of thin air, all of which is piled on the belly and can’t fit into the pants they used to wear. Don’t blame yourself for your “poor metabolism” first. Take the time to check your hormones. In all likelihood, your free testosterone level can’t keep up. I have also seen many people who used to have a carefree personality. Suddenly, for half a year, they suddenly become irritable at every turn, or they just don’t want to do anything. They feel tired even when they lie down and scroll through their mobile phones. They went to a psychiatric department for a check-up and found no anxiety or depression. Finally, after adjusting their testosterone levels for 3 months, their overall state of mind returned directly.

By the way, don’t believe the nonsense on the Internet that “androgenetic atrophy means too high testosterone”. This has also been a controversial point in the industry for a long time. The mainstream view of dermatology is that androgenetic alopecia mainly depends on the sensitivity of dihydrotestosterone (DHT) and hair follicle receptors. Many young men with androgenic alopecia have total testosterone that is actually lower than the normal value. It is just that there is more 5α reductase in the body, and the DHT converted is higher than others. If you use any folk remedies to suppress androgen, the more you use it, the lower the total testosterone may be, and the hair loss will be more severe. Some people think that working out and building muscles can increase testosterone. This is not true. Moderate strength training 3-4 times a week is indeed useful, but if you practice until you vomit every day, the caloric gap will be wider than the Pacific Ocean, which will suppress testosterone. I once had a bodybuilder who was preparing for a competition come to me. His body fat rate is only 7%, his abdominal muscles are clearly defined, and his total testosterone is less than 10nmol/L. He has overtrained.

To be honest, most men are too careless about their hormonal health. They either think that this thing is just for that need, and don’t bother with it if they don’t have any ideas. Or they think that as long as there is no arrow on the test sheet, it is normal, without considering variables such as age and underlying diseases at all. Most hospitals’ testosterone reference values ​​cover all ages from 18 to 80 years old. A 25-year-old boy takes the lower limit of a 60-year-old man as the normal standard, so of course he thinks he is fine. Of course, there’s no need to be too anxious. If you drank a lot and stayed up all night the night before, it’s normal to find out that your testosterone levels are low. Just check again on an empty stomach every two weeks. If something is really wrong, stay up less late and supplement with zinc and vitamin D. Most people can get back to normal levels and don’t make the mistake of taking testosterone injections as soon as they start.

After all, this thing is like the engine oil in your car. If you have nothing to do, you should just glance at the warning light on the dashboard and don't wait for the engine to pull cylinder before you think about repairing it, right?