Men’s Hormone Panel

Not feeling like yourself?

Symptoms of Hormone Imbalance

Decreased sex drive / Erectile Dysfunction

Increased weight gain or fat accumulation and Muscle weakness or loss of muscle

Depression / Irritability

Fatigue / Insomnia

Increase in breast tissue (gynecomastia)

Osteoporosis

Difficulty concentrating


As we age, our bodies change and hormone levels change too. Feeling your best means your hormones need to be in balance. Getting tested will help you and your doctor discover what your body needs to be in balance.


*In men over 35 or those undergoing testosterone therapy, it is suggested to monitor prostate health
See Test Code 4006 for PSA


Low T and Opioid Medications

Nearly 1 out of 4 men over 30 may suffer from low testosterone levels. Opioid medications reduce testosterone levels and in turn low testosterone and vitamin D may potentially reduce the efficacy of opioids. By monitoring the hormone system while on opioid medication can help doctors prevent irreversible endocrine system damage.


What is tested?

Test

Clinical significance as related to E2 or female hormone regulation

Total Testosterone

This is the total amount of testosterone circulating in the blood, whether bound to protein or free (unbound and biologically active fraction). A low overall level may be consistent with a diagnosis of hypogonadism or OPIAD.

Free Testosterone

In recent years the diagnosis of Low T has favored the use of Free Testosterone, which is the portion (~3-4%) in blood not bound to sex hormone binding globulin (SHBG), and to a lesser extent to albumin. Thus it is available for the body to use. The amount of testosterone that is bound is very consistent, so Free T can be calculated (instead of directly measured). This calculation is based on measurement of total testosterone, SHBG, and albumin.

Bioavailable Testosterone

In addition to SHBG, Testosterone is bound weakly to Albumin (~30% bound). Because testosterone bound to albumin may dissociate, this fraction is also considered “bioavailable” to cells. The bioavailable fraction as it relates to albumin can therefore also be calculated and added to free testosterone for clinical consideration.

TSH

Measurement of thyroid stimulating hormone (TSH) may assist in diagnosing primary hypogonadism. In men with elevated FSH, the underlying etiology either is related to primary hypogonadism (and concomitant primary hypothyroidism) or a gonadotroph adenoma. Under these circumstances the following laboratory tests may be indicated:

  • LH and Testosterone levels
  • In patients with gonadotroph adenomas, other pituitary hormone levels must be assessed because macroadenomas may induce hypopituitarism: TSH and free thyroxine (FT4), morning cortisol and adrenocorticotropic hormone (ACTH), prolactin, and, occasionally, dynamic testing for growth hormone (GH) may be necessary.

LH

Luteinizing hormone (LH) is a gonadotropin released by the pituitary glands that acts synergistically with follicle stimulating hormone (FSH) to stimulate testosterone production in males. In cases of Low T, it is important to know if there is an underlying issue with the pituitary glands that would lead to reduced production; LH will be low or low-normal in secondary hypogonadism and high in primary hypogonadism.

FSH

FSH is another gonadotropin released by the pituitary gland that stimulates testicular growth. It also increases production of androgen binding protein, which helps concentrate testosterone levels near the sperm, influencing fertility. FSH measurement (along with LH) can help indicate whether primary (high FSH) or secondary (low or low-normal FSH) hypogonadism is the underlying cause of low T.

DHEA-S

Dehydroepiandrosterone sulfate (DHEA-S) is the most abundant circulating steroid hormone and is produced in the adrenal glands, gonads, and brain; it is the key upstream hormone in the adrenal pathway for testosterone production. If DHEA-S levels are low, over the counter supplements can be given to correct some of the symptoms of hypogonadism.

Progesterone

Progesterone is a powerful counter-balance for estrogen. The role progesterone plays in men is not fully understood, but research indicates it may play a role in reducing the conversion of testosterone to DHT, which in turn plays a role in the development of prostate cancer. Progesterone is also an intermediate precursor in the production of testosterone, other sex steroid, and mineralocorticoids. Because of its regulatory role in cellular function (progesterone receptors are present on many cells) there is a great interest in researching the effect of progesterone maintenance with age in both sexes6

Estradiol (E2)

Estradiol plays an important role in secondary hypogonadism as it has negative feedback on gonadotropin release. In this form of secondary hypogonadism testosterone will continue to decrease while estradiol increases. As this continues (becomes chronic) the ratio of free testosterone to estradiol can reach a critical point where estrogen suppression of gonadotropins predominates and may become irreversible; i.e., lead to permanently inhibited testosterone production7

25-OH Vitamin D

25-OH Vitamin D is a hormone precursor that plays a role in many pathways related to Testosterone function including bone density, depression, and opioid function. Chronically low vitamin D may also play a role in the incidence of acute and chronic pain overall.8

Test Code: 6804

CPT: 82040;82530;82627;83001;83002;84144;84146;84270;84403;82306
Tests Included DHEA-S, FSH, LH, TSH, Estradiol, Progesterone, SHBG, Testosterone - Total, Testosterone-Free, Testosterone-Bioavailable, 25OH Vitamin D
Patient Preparation None
Sample Serum or Plasma
Tube 2x Red, Green or Tiger Top
Test Turnaround Time 5 Days
Intended Patient Population 18+ and Older Adult Males
Shipping Requirements Overnight, Refrigerated
Specimen Stability 7 Days RT
4 Days RF
Reject Criteria See Individual Component Test Requirements
Laboratory Developed Test (LDT) Yes
CMS Guidance LCD L36692

References

  1. K. Vincent, I. Tracey, Hormones and their Interaction with the Pain Experience, Rev Pain. 2008 Dec; 2(2): 20–24.
  2. Endocrine Society. "Testosterone therapy may help improve pain in men with low testosterone." ScienceDaily. ScienceDaily, 17 June 2013. <www.sciencedaily.com/releases/2013/06/130617142047.htm>
  3. T.W. Kragstrup, MD, Vitamin D supplementation for patients with chronic pain, Scand J Prim Health Care. 2011 Mar; 29(1): 4–5
  4. T. Jarvis, B. Chughtai, and S. Kaplan, Testosterone and benign prostatic hyperplasia, Asian J Androl. 2015 Mar-Apr; 17(2): 212–216.
  5. National Cancer Institute. “Prostate-Specific Antigen (PSA) Test.” June 13, 2017, <https://www.cancer.gov/types/prostate/psa-fact-sheet#q2>
  6. M. Oettel and A. K. Mukhopadhyay, Progesterone: the forgotten hormone in men? The Aging Male 2004;7:236–257
  7. Cohen PG, The role of estradiol in the maintenance of secondary hypogonadism in males in erectile dysfunction. Med Hypotheses. 1998 Apr;50(4):331-3.
  8. E. E. Shipton and E. A. Shipton, Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States, Pain Ther. 2015 Jun; 4(1): 67–87.

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