March 31, 2014

Low T is a Clinical Diagnosis

It’s hard to turn on the TV these days and not see a commercial either about erectile dysfunction or low T (for low testosterone). But, what is low T? It refers to a constellation of signs and symptoms that result from testosterone levels dropping below some critical threshold. Where that critical threshold is, though, varies from man to man, as well as woman to woman. And, that varying goal post creates quite a bit of confusion.

A vast majority of doctors diagnose low T purely on blood testosterone levels alone. If you have symptoms and your testosterone level is within the reference range, mistakenly called the “normal range”, they will not treat you even if you have every symptom attributable to low testosterone. Physicians who specialize or focus on treating men for low testosterone typically do not rely only on blood tests alone, however. They base their decision to treat more on a man’s symptoms. That’s called making a clinical diagnosis of low T.

The Clinical Diagnosis of Low T

A new study published online in Urology (available in print in May, 2014) concludes that blood tests alone are not sufficient to diagnose low testosterone in men. One reason for that is the laboratory measurement of testosterone levels can be inaccurate an vary as much as 30% from one laboratory to the next. But, the more fundamental reason is this. If a patient has symptoms then his testosterone level is too low for him irrespective of whatever level he has.

Making a clinical diagnosis is nothing new – just new to diagnosing low T. Post-menopausal women are treated many times simply based only on their symptoms. In fact, many women receive hormone replacement therapy without ever having the their blood hormone levels measured (we don’t advise that). Depression is a clinical diagnosis, too. It’s made largely based on what the patient tells the doctor.

But, for some reason doctor’s have been reluctant to make a clinical diagnosis of low testosterone. I think some of that has to do with the fact that testosterone is a controlled substance, and some doctors may prefer a more rigid or pre-deteremined way to make the diagnosis of low testosterone before prescribing a controlled substance.

For those who of us who frequently treat men for low testosterone this new study is a welcome relief. But, I bet it will take some time before most physicians are willing to give up relying only on the results of the blood tests before they diagnose a man with low T. Just a hunch.

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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