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The Importance of PSA Testing The Prostate-specific antigen or PSA test is a blood test that can be used as a measurement of prostate health. According to a March 2009 European study published in the New England Journal of Medicine (1), the PSA test is not only a valid screening test for prostate cancer but could also significantly reduces mortality from this disease in middle-aged men. Table of Contents The Importance of PSA Testing What is a PSA Test? Elevated Prostate Specific Antigen The Significance of Free PSA What if the Test Shows an Elevated PSA level? Getting Tested The PSA Controversy What is a PSA Test? The PSA test was initially approved by the US Food and Drug Administration (FDA) in 1986 to track the progression of prostate cancer in individuals who have been previously diagnosed with the disease. In 1994, the use of the PSA test together with a digital rectal exam (DRE) was approved by the FDA to test asymptomatic men for prostate cancer. Men who experience prostate symptoms will usually undergo a PSA test (with a DRE) to help a urologist determine what’s causing the problem. Elevated Prostate Specific Antigen Prostate-specific antigen (PSA) is a protein secreted by healthy, as well as cancerous cells in the prostate gland. A PSA test is commonly used to measure the level of this protein in someone’s blood. This test is conducted by taking a blood sample and sending it to a laboratory for analysis. PSA test results are typically recorded as nanograms of PSA per milliliter (ng/mL) of blood. In men with prostate cancer, the blood level of PSA is frequently elevated. Although research does indicate that having an elevated PSA level does not always mean that a man has prostate cancer (2). PSA levels may also become elevated because of benign enlargement of the prostate gland as well as prostatitis (inflammation of the prostate) due to infection. It’s crucial to emphasize that a PSA test is not a specific prostate cancer test, but it’s a critical first step in checking for the possible presence of prostate cancer. There are other factors that could cause your PSA levels to increase (3): Advancing age; PSA levels tend to rise with age. Inflammation of the prostate gland, from either infection or some other undetermined cause. Benign prostatic hyperplasia (BPH); also called an enlarged prostate. A larger prostate has more cells secreting PSA, increasing the odds for an elevated PSA level. Prostate cells could be inflamed by a Urinary tract infection, causing PSA levels to go up. Ejaculation can cause a mild elevation in the PSA score, but levels return to normal after only a few days. The recommendation is that men abstain from sex for at least 48 hours before PSA testing Anything that might cause trauma to the prostate like; bike riding, catheter insertion into the bladder, prostate biopsy, or cystoscopy can temporarily increase PSA levels. Conversely, some medicines (Proscar, Avodart, Propecia) (4) could lower your PSA. If you’re taking any of these medications, you should advise your doctor. A PSA level of less than 4.0 ng/mL is considered to be normal, but changes of more than 2.0 ng/mL over a year may indicate that prostate cancer is present (5). The Significance of Free PSA PSA circulates through the body in two ways; bound to other proteins or by itself. Unbound PSA is called free PSA. A free-PSA test will measure the percentage of unbound PSA while a PSA test is used to measure the total of free and bound PSA in the blood (6). The free PSA is a defective variant of normal PSA that can no longer bind to other proteins and so circulates in the blood in the free form. Although the reason why is poorly understood - patients with cancer may have lower free PSA levels than those with a benign prostate condition (6). What if the Test Shows an Elevated PSA level? If someone who isn’t experiencing the symptoms of prostate cancer decides to take a PSA test and discovers that he has an elevated PSA level the urologist could advise him to take another PSA test to confirm the original result. When results show that the PSA level is still elevated, the doctor could then recommend that he continue to be tested and digitally examined at regular intervals to detect changes (if any) over time (6). When the PSA level continues to rise or if a lump is detected during a digital examination, additional tests could be prescribed to discover possible causes (7). These tests can include: Urine test to check for a urinary tract infection Transrectal ultrasound X-rays Cystoscopy If the doctor suspects prostate cancer is present, then a prostate biopsy may be recommended. This procedure is used to collect multiple samples of prostate tissue by inserting hollow needles into the prostate gland and then withdrawing them. Frequently, the needles will be inserted through the wall of the rectum in a procedure called a transrectal biopsy. A pathologist then studies the collected prostate tissue with a microscope. An ultrasound may also be used to view the prostate during the biopsy, although ultrasound alone can’t be used to make a prostate cancer diagnosis. Getting Tested The accepted recommendation is that once a man reaches 40 years of age, he should begin having his prostate checked to establish a baseline for future monitoring. With a baseline set, the doctor can act quickly if PSA level changes indicate a potential problem (8). Unfortunately, many men underestimate the importance of setting a PSA baseline from a younger age. Establishing your baseline PSA level means that if there is even a small change in PSA levels - your doctor can quickly begin the necessary procedures to find out what may be causing the change and commence proper treatment if it’s indicated, possibly saving your life (9). The PSA Controversy The PSA test is not a cancer test. The test is only used to determine the level of PSA in a man’s blood. A high PSA score may indicate the presence of prostate cancer – but there are many factors that can cause PSA levels to be elevated, from infection to resent ejaculation. Another problem is that the PSA test also cannot distinguish between elevated PSA as a result of a benign cancer that will pose no threat in the course of a normal lifetime, or from the presence of an aggressive tumor that poses a much more immediate threat (10). Regardless, current research still indicates that PSA is a valid and proven marker that can be used together with other variables for determining the chance that an aggressive prostate cancer is present (10). References 1) SchröderFH,Hugosson J,Roobol MJ, et al.Screening and prostate cancer mortality in a randomized European study, N Engl J Med, 2009, vol. 360 13(pg. 1320-1328). 2) O'Shaughnessy M, Konety B, Warlick C. Prostate cancer screening: issues and controversies. Minnesota Medicine, August 2010. 3) Mayo Clinic Staff. PSA Test. (N.D.). https://www.mayoclinic.org/tests-procedures/psa-test/details/risks/cmc-20200313 4) Pannek J, Marks LS, Pearson JD, Rittenhouse HG, Chan DW, Shery ED, Gormley GJ, Subong EN, Kelley CA, Stoner E, Partin AW. Influence of finasteride on free and total serum prostate specific antigen levels in men with benign prostatic hyperplasia. The Journal of Urology. 1998. 5) Carter, H. Ballentine et al. “Detection of Life-Threatening Prostate Cancer With Prostate-Specific Antigen Velocity During a Window of Curability.” Journal of the National Cancer Institute 98.21 (2006): 1521–1527. PMC. Web. 24 Nov. 2017. 6) Mione R1, Barioli P, Barichello M, Zattoni F, Prayer-Galetti T, Plebani M, Aimo G, Terrone C, Manferrari F, Madeddu G, Caberlotto L, Fandella A, Pianon C, Vianello L, Gion M. Prostate cancer probability after total PSA and percent free PSA determination. Int J Biol Markers. 1998 Apr-Jun;13(2):77-86. 7) Wilt, Timothy J et al. “Prostate Cancer: Epidemiology and Screening.” Reviews in Urology 5.Suppl 6 (2003): S3–S9. Print. 8) Larsen, Signe Benzon et al. “Baseline PSA Measurements and Subsequent Prostate Cancer Risk in the Danish Diet, Cancer and Health Cohort.” European journal of cancer (Oxford, England : 1990) 49.14 (2013): 3041–3048. PMC. Web. 24 Nov. 2017. 9) Weight, Christopher J. et al. “Men (Aged 40–49 Years) With a Single Baseline Prostate-Specific Antigen Below 1.0 ng/mL Have a Very Low Long-Term Risk of Prostate Cancer: Results From a Prospectively Screened Population Cohort.” Urology 82.6 (2013): 1211–1217. PMC. Web. 24 Nov. 2017. 10) H Ballentine Carter. Differentiation of lethal and non lethal prostate cancer: PSA and PSA isoforms and kinetics. Asian Journal of Andrology. 2012 May; 14(3): 355–360.  

Table of Contents What is a PSA Test? Elevated Prostate Specific Antigen The Significance of Free PSA What if the Test Shows an Elevated PSA level? Getting Tested The PSA Controversy The Prostate-specific antigen or PSA test is a blood test that can be used as a measurement of prostate health.  According to a March 2009 European study published in the New England Journal of Medicine (1), the PSA test is not only a valid screening test for prostate cancer but could also significantly reduces mortality from this disease in middle-aged men.    What is a PSA Test? The PSA test was initially approved by the US Food and Drug Administration (FDA) in 1986 to track the progression of prostate cancer in individuals who have been previously diagnosed with the disease. In 1994, the use of the PSA test, together with a digital rectal exam (DRE) was approved by the FDA to test asymptomatic men for prostate cancer. Men who experience prostate symptoms will usually undergo a PSA test (with a DRE) to help a urologist determine what’s causing the problem.   Elevated Prostate Specific Antigen Prostate-specific antigen (PSA) is a protein secreted by healthy, as well as cancerous cells in the prostate gland. A PSA test is commonly used to measure the level of this protein in someone’s blood. This test is conducted by taking a blood sample and sending it to a laboratory for analysis. PSA test results are typically recorded as nanograms of PSA per milliliter (ng/mL) of blood. In men with prostate cancer, the blood level of PSA is frequently elevated. Although research does indicate that having an elevated PSA level does not always mean that a man has prostate cancer (2). PSA levels may also become elevated because of benign enlargement of the prostate gland as well as prostatitis (inflammation of the prostate) due to infection. It’s crucial to emphasize that a PSA test is not a specific prostate cancer test, but it’s a critical first step in checking for the possible presence of prostate cancer. There are other factors that could cause your PSA levels to increase (3):   Advancing age; PSA levels tend to rise with age. Inflammation of the prostate gland, from either infection or some other undetermined cause. Benign prostatic hyperplasia (BPH); also called an enlarged prostate.  A larger prostate has more cells secreting PSA, increasing the odds for an elevated PSA level. Prostate cells could be inflamed by a urinary tract infection, causing PSA levels to go up. Ejaculation can cause a mild elevation in the PSA score, but levels return to normal after only a few days. The recommendation is that men abstain from sex for at least 48 hours before PSA testing Anything that might cause trauma to the prostate like; bike riding, catheter insertion into the bladder, prostate biopsy, or cystoscopy can temporarily increase PSA levels.   GET A PSA TEST HERE   Conversely, some medicines (Proscar, Avodart, Propecia) (4) could lower your PSA.  If you’re taking any of these medications, you should advise your doctor.  A PSA level of less than 4.0 ng/mL is considered to be normal, but changes of more than 2.0 ng/mL over a year may indicate that prostate cancer is present (5).   The Significance of Free PSA PSA circulates through the body in two ways; bound to other proteins or by itself. Unbound PSA is called free PSA. A free-PSA test will measure the percentage of unbound PSA while a PSA test is used to measure the total of free and bound PSA in the blood (6). The free PSA is a defective variant of normal PSA that can no longer bind to other proteins and so circulates in the blood in the free form. Although the reason why is poorly understood - patients with cancer may have lower free PSA levels than those with a benign prostate condition (6).   GET A FREE PSA/TOTAL PSA RATIO TEST   What if the Test Shows an Elevated PSA level? If someone who isn’t experiencing the symptoms of prostate cancer decides to take a PSA test and discovers that he has an elevated PSA level the urologist could advise him to take another PSA test to confirm the original result. When results show that the PSA level is still elevated, the doctor could then recommend that he continue to be tested and digitally examined at regular intervals to detect changes (if any) over time (6). When the PSA level continues to rise or if a lump is detected during a digital examination, additional tests could be prescribed to discover possible causes (7). These tests can include:   Urine test to check for a urinary tract infection Transrectal ultrasound X-rays  Cystoscopy   If the doctor suspects prostate cancer is present, then a prostate biopsy may be recommended. This procedure is used to collect multiple samples of prostate tissue by inserting hollow needles into the prostate gland and then withdrawing them. Frequently, the needles will be inserted through the wall of the rectum in a procedure called a transrectal biopsy. A pathologist then studies the collected prostate tissue with a microscope. An ultrasound may also be used to view the prostate during the biopsy, although ultrasound alone can’t be used to make a prostate cancer diagnosis.   Getting Tested The accepted recommendation is that once a man reaches 40 years of age, he should begin having his prostate checked to establish a baseline for future monitoring. With a baseline set, the doctor can act quickly if PSA level changes indicate a potential problem (8). Unfortunately, many men underestimate the importance of setting a PSA baseline from a younger age. Establishing your baseline PSA level means that if there is even a small change in PSA levels - your doctor can quickly begin the necessary procedures to find out what may be causing the change and commence proper treatment if it’s indicated, possibly saving your life (9).   The PSA Controversy The PSA test is not a cancer test. The test is only used to determine the level of PSA in a man’s blood. A high PSA score may indicate the presence of prostate cancer – but there are many factors that can cause PSA levels to be elevated, from infection to resent ejaculation. Another problem is that the PSA test also cannot distinguish between elevated PSA as a result of benign cancer that will pose no threat in the course of a normal lifetime or from the presence of an aggressive tumor that poses a much more immediate threat (10). Regardless, current research still indicates that PSA is a valid and proven marker that can be used together with other variables for determining the chance that aggressive prostate cancer is present (10).   References   1) SchröderFH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality in a randomized European study, N Engl J Med, 2009, vol. 360 13(pg. 1320-1328).   2) O'Shaughnessy M, Konety B, Warlick C. Prostate cancer screening: issues and controversies.MinnesotaMedicine, August 2010.   3) Mayo Clinic Staff. PSA Test. (N.D.). https://www.mayoclinic.org/tests-procedures/psa-test/details/risks/cmc-20200313   4) Pannek J, Marks LS, Pearson JD, Rittenhouse HG, Chan DW, Shery ED, Gormley GJ, Subong EN, Kelley CA, Stoner E, Partin AW. Influence of finasteride on free and total serum prostate-specific antigen levels in men with benign prostatic hyperplasia. The Journal of Urology. 1998.   5) Carter, H. Ballentine et al. “Detection of Life-Threatening Prostate Cancer with Prostate-Specific Antigen Velocity During a Window of Curability.” Journal of the National Cancer Institute 98.21 (2006): 1521–1527. PMC. Web. 24 Nov. 2017.   6) Mione R1, Barioli P, Barichello M, Zattoni F, Prayer-Galetti T, Plebani M, Aimo G, Terrone C, Manferrari F, Madeddu G, Caberlotto L, Fandella A, Pianon C, Vianello L, Gion M. Prostate cancer probability after total PSA and percent free PSA determination. Int J Biol Markers. 1998 Apr-Jun;13(2):77-86.   7) Wilt, Timothy J et al. “Prostate Cancer: Epidemiology and Screening.” Reviews in Urology 5. Suppl 6 (2003): S3–S9. Print.   8) Larsen, Signe Benzon et al. “Baseline PSA Measurements and Subsequent Prostate Cancer Risk in the Danish Diet, Cancer and Health Cohort.” European journal of cancer (Oxford, England: 1990) 49.14 (2013): 3041–3048. PMC. Web. 24 Nov. 2017.   9) Weight, Christopher J. et al. “Men (Aged 40–49 Years) With a Single Baseline Prostate-Specific Antigen Below 1.0 ng/mL Have a Very Low Long-Term Risk of Prostate Cancer: Results from a Prospectively Screened Population Cohort.” Urology 82.6 (2013): 1211–1217. PMC. Web. 24 Nov. 2017.   10) H Ballentine Carter. Differentiation of lethal and nonlethal prostate cancer: PSA and PSA isoforms and kinetics. Asian Journal of Andrology. 2012 May; 14(3): 355–360.

Understanding High PSA Levels: A Prostate Health Guide PSA is also known as the prostate-specific antigen. This is a protein that your prostate gland naturally produces. In healthy individuals, PSA levels are small all the time, and this type of protein circulates freely through the bloodstream. However, doctors and researchers have discovered that PSA can get really high sometimes. This is usually because the patient has a significant prostate infection or prostate cancer. Developing prostate cancer is something that scares most people, but luckily, high PSA levels don't necessarily mean that you have cancer. Dive into this article and learn why sometimes your PSA levels are high, yet this is not a diagnosis for cancer. Table of Contents Understanding High PSA Levels: A Prostate Health Guide What Are Normal PSA Levels? Your Age Might Naturally Increase PSA Levels Prostatitis Can Also Cause High PSA Levels Having a Recent Medical Procedure Might Raise PSA Levels Benign Prostatic Hyperplasia Could Also Cause High PSA Levels If You Exercise Often, Your PSA Levels Might Increase. Having a urinary tract infection could cause high PSA levels Why Should You Order a PSA Test? Free PSA vs. Regular PSA Test Order Your PSA Test From DiscountedLabs Today! What Are Normal PSA Levels? PSA can fluctuate in the bloodstream depending on various factors. However, individuals who don't have prostate cancer have PSA levels under 4 ng/mL. Most often, healthy men have PSA levels revolving around 1-2 ng/mL. At the same time, scientists have discovered that PSA levels above 4 ng/ml usually translate into prostate cancer. Some cancer patients have PSA levels above 6 or even 7 ng/ml, and they usually receive some sort of treatment to bring these levels down. Your Age Might Naturally Increase PSA Levels Now that you know what the normal levels of PSA are, it's time to see how age affects it. Men who are 50 years of age or older begin to see a significant spike in their PSA levels. This happens because the prostate tissue naturally produces more PSA. Men in their 70s usually have higher PSA levels than normal. However, this doesn't automatically mean that they have cancer. In many cases, screening seniors for PSA levels might result in false positives. Other types of tests are necessary, besides a PSA test, to determine if a patient has cancer or not. Therefore, if you or your dad have high PSA levels, you shouldn't be scared because this doesn't usually translate into prostate cancer. Prostatitis Can Also Cause High PSA Levels Prostatitis is nothing but an inflammation of the prostate tissue. It can happen to men of all ages, and it comes with various symptoms. For example, patients who have prostatitis experience mild fever, difficulty urinating, or painful ejaculations. Feeling pressure in the rectum area is another sign of prostatitis. Some men may experience something known as chronic nonbacterial prostatitis or chronic pelvic pain syndrome. These individuals with CNP or CPPS might experience symptoms similar to prostatitis. For example, they might complain of mild lower back pain, painful ejaculation, and discomfort in the pelvic area. In some cases, prostatitis can be asymptomatic as well. For many patients, prostatitis can be a chronic problem, but this is not a confirmed diagnosis for prostate cancer. Having a Recent Medical Procedure Might Raise PSA Levels Different types of medical procedures done on the prostate tissue or urinary tract might make the prostate produce more PSA. For example, if you've had a recent prostate exam, your PSA levels are probably higher than normal. At the same time, having a urinary catheter inserted in the urethra can cause mild irritation and make the prostate tissue release more PSA. As a rule of thumb, patients should wait a few weeks after having a procedure before they take a PSA test. Benign Prostatic Hyperplasia Could Also Cause High PSA Levels Benign prostatic hyperplasia, or BPH, is another reason why your PSA levels are high, but you don't have prostate cancer. This type of condition is frequently encountered among older men. It is an enlargement of the prostate tissue, and it's usually accompanied by symptoms similar to prostatitis. At the same time, BPH can have similar symptoms as those experienced by those with prostate cancer. This includes painful urination and problems with ejaculation. If You Exercise Often, Your PSA Levels Might Increase. Different types of vigorous exercises, such as running or high-intensity interval training, can increase your PSA levels and potentially contribute to prostate problems. They will eventually remain elevated for a few days. That's why you need to stop exercising for at least two days before going for an early-detection PSA test. Bicycle riding is especially linked to potentially increased PSA levels. Factors that might affect PSA levels include certain medicines, such as 5-alpha reductase inhibitors like finasteride (Proscar or Propecia) or dutasteride (Avodart), which can lower PSA levels. According to the National Cancer Institute, a PSA test can find high levels of PSA that may mean a person has prostate cancer. An elevated PSA level can also be caused by other problems with the prostate, like an enlarged or inflamed prostate. Therefore, determining what a high PSA score means can be complicated. To decide whether to have a PSA test, discuss the issue with your doctor, considering your risk factors and weighing your personal preferences. A higher level of PSA means a higher risk of prostate cancer. A high PSA level can be the first sign of prostate cancer and can also indicate less serious conditions, such as an enlarged prostate. Keep up with your regular appointments and tests so your care team can keep tabs on your health. If you’re experiencing prostate symptoms, such as an enlarged prostate, dull pain in the lower pelvic area, frequent urination, and pain or difficulty while urinating, it is important to consult a healthcare professional for further evaluation and diagnosis. If your PSA level is high, a prostate biopsy is the only way to find out if the cause is cancer. And prostate biopsies have possible harm. Having a urinary tract infection could cause high PSA levels Urinary tract infections might also increase your PSA levels. These are common among men, and they can cause irritation to the prostate tissue. As a result, the prostate will produce more PSA and give a false positive for prostate cancer to a PSA test. The level of the urinary tract infection can also affect how much PSA the prostate produces. For example, those who experience painful urination, blood in the urine, and other serious symptoms usually have their PSA levels increase. Why Should You Order a PSA Test? It's important to understand that you can have various symptoms, such as painful urination, pelvic pain, abdominal discomfort, and back pain, without having prostate cancer. One or more of the previously mentioned conditions frequently cause these symptoms. However, those who do indeed have prostate cancer and are unaware of it experience these symptoms. That's why it's important to do a PSA test as soon as you start to experience one or more of the symptoms presented in this article. If your PSA levels are slightly higher, your doctor might take you through other types of tests to determine if you really have prostate cancer or not. Most patients don't, so don't get scared right away. If your PSA levels are very high and other tests indicate that your prostate might be cancerous, it's best to discover it as soon as possible, right? Your doctor might recommend various treatment methods to help you keep your PSA levels under control. In any case, it's very important to do a PSA test, especially if you're older and experience recurring pelvic pain or discomfort while urinating. Free PSA vs. Regular PSA Test When PSA levels are elevated, free PSA can be used as a marker to help determine if prostate cancer is a possibility. Free PSA is the amount of PSA in the blood that is not bound to other proteins. A low percentage of free PSA may indicate a higher likelihood of aggressive prostate cancer. An enlarged prostate, BPH, and certain medications can also cause high PSA levels. To confirm a diagnosis, additional tests may be needed beyond just a PSA test. Essential Tips for PSA Test Preparation Proper preparation before your PSA test is essential to ensuring accurate results. While the test itself is straightforward, there are certain steps you can take to help maximize the accuracy of your test results. Before your PSA test, it's important to inform your healthcare provider about any medications you are taking, as some medications can affect PSA levels. Your healthcare provider may advise you to temporarily stop taking certain medications before the test. Additionally, it's recommended to avoid sexual activity, ejaculation, and vigorous exercise for at least 24 hours before your PSA test, as these activities can temporarily increase PSA levels. Fasting is not typically required before a PSA test. Steps to Take Before Your Test Before your PSA test, there are several steps you can take to ensure accurate results: Inform your healthcare provider about any medications you are taking, as some medications can affect PSA levels. Avoid sexual activity, ejaculation, and vigorous exercise for at least 24 hours before your test, as these activities can temporarily increase PSA levels. It is not typically necessary to fast before a PSA test, but it's always a good idea to follow any specific instructions provided by your healthcare provider. Be prepared to provide a blood sample during your appointment. The blood sample will be used to measure the level of PSA in your blood. What to Avoid Prior to Your Test To ensure accurate results from your PSA test, it's important to avoid certain factors that can affect PSA levels: Avoid ejaculation and sexual activity for at least 24 hours before your test, as these activities can temporarily increase PSA levels. Refrain from vigorous exercise or activities that put pressure on the prostate gland, such as bicycle riding, as this can also affect PSA levels. Inform your healthcare provider about any medications you are taking, as some medications can affect PSA levels. Your healthcare provider may advise you to temporarily stop taking certain medications before the test. It's important to note that certain factors, such as an enlarged prostate (benign prostatic hyperplasia), can also cause elevated PSA levels. Your healthcare provider will take into consideration your individual risk factors and medical history when interpreting your PSA test results. Order Your PSA Test From DiscountedLabs Today! You might be happy to find out that prostate cancer screening, including the PSA screening test and urine test, for different types of prostate cancer diagnosis is much more affordable these days. Order your blood test for PSA screening from DiscountedLabs and get your test results back in just a few business days. You don't even need your doctor's approval; you just order the PSA test, offer a blood sample to a nearby clinic, and receive your test results back by email. Ideally, a small PSA test is used for men who have at least 10 years of life expectancy or are being evaluated for a metastatic prostate cancer diagnosis. In general, we recommend prostate cancer screening for men ages 55 to 69, unless a male has a higher risk of prostate cancer diagnosis (a family history, being of African American descent), in which case we screen at age 50. This aligns with guidelines from the U. The next step after a positive PSA level or rectal exam indicating possible prostate cancer is a biopsy. This is a test where the doctor takes a small amount of tissue from your prostate and sends it to a lab for testing. It’s the only way to be sure you have cancer. It has never been easier to check the health of your prostate, so order your PSA test today.  

Table of Contents SHBG and the Free Testosterone Relationship What Causes High SHBG? Other factors that can contribute to high SHBG include:   Get Your Levels Checked: SHBG Test, Free & Total Testosterone Test How to Lower SHBG Levels: Very Low SHBG : Low SHBG has also been associated with: Is SHBG an Enemy of Hormone? - Emerging Studies References: Testosterone is the primary and dominant male hormone. It is responsible for numerous functions within the human body in men and women, and when levels are too low, it can lead to multiple health issues. Unfortunately, as many know, testosterone levels naturally decline as we age. Numerous external factors can contribute to lower levels of testosterone. In either case, age or external, symptoms occur, problems arise, and solutions are needed to stop the decline. For many men, testosterone replacement therapy (TRT) is the answer to this problem.  Men should ensure that their testosterone free and total, estradiol and other hormone factors are within normal levels. One of those hormone tests to monitor is the Sex Hormone Binding Globulin (SHBG) test.   SHBG and the Free Testosterone Relationship   When our body produces testosterone or provides it exogenously, a set level of testosterone flows through the body. This testosterone blood level can be measured precisely through a simple blood test aptly referred to as the Total Testosterone blood test. For most adult men, when testing their total testosterone, if it falls in the 350 ng/dl to 1100 ng/dl range, this will be considered medically optimal. Such individuals, even exhibiting low testosterone symptoms, will often not be prescribed TRT. In some cases, this may be a correct diagnosis; in other cases, symptoms exist for different reasons, but in most cases, something else is at play, which makes SHBG important.   While useful, measuring total testosterone is only useful with also measuring Free Testosterone. Free testosterone is a small fraction of your total testosterone. It is often referred to as "unbound," meaning the testosterone your body will use for its intended androgenic function. Free testosterone is so important that if your total testosterone levels are within range, if free testosterone levels are low, in most cases, the man will be symptomatic of low testosterone. This issue is often due to high levels of SHBG in the body.   For this reason, many men will attempt to lower their SHBG or even fret over it. However, SHBG serves an essential purpose. As is with estrogen, too much can be problematic, but so can too little. SHBG is no different.   Of all the testosterone flowing through your body, only 2% is what we can refer to as unbound or free testosterone. From a layman's perspective, to increase free and unbound testosterone, they'd need to increase their total testosterone. Unfortunately, it doesn't always work that way – it often helps and often fixes the issue, but not always – and here's why: our testosterone is bound to albumin and sex hormone-binding globulin (SHBG). Approximately one-third of total testosterone binds to albumin, and the rest to SHBG.   Albumin is a protein that binds testosterone, and we can say it does so loosely. This protein carries testosterone through the bloodstream and releases it as needed. The testosterone detaches and becomes what's often referred to as bioavailable or free testosterone. The testosterone that separates from albumin becomes the testosterone that influences your body's functions from sex organs, muscle tissue, brain function, and a host of other areas of bodily function. Testosterone attached to SHBG cannot do this; it is attached and does not detach.   What Causes High SHBG?   As testosterone attached to SHBG is relatively useless, if SHBG levels increase within the body, there will be more attaches and less free testosterone to circulate. Conversely, lower levels of SHBG are associated with higher levels of free testosterone, which is often associated with positive influences on bodily functions, such as libido, mood, muscle mass, etc.   Numerous factors influence how much sex hormone-binding globulin we have in our bodies. Age is one of the primary factors that affect SHBG. Often as we age, SHBG levels increase, and as a result, free testosterone levels go down. Even if our total testosterone levels remain high or optimal, our bioavailable testosterone decreases if SHBG levels increase.   Other factors that can contribute to high SHBG include: Fatty Liver Excessive or what we might call chronic alcohol consumption can lead to a fatty liver and impending higher levels of SHBG and corresponding lower levels of free testosterone. The disease can also be a factor, such as cirrhosis or cancer. Thyroid issues An underactive and overactive thyroid can lead to elevated SHBG, not to mention issues associated with the thyroid. Overactive thyroid or hyperthyroidism is often associated with graves' disease, thyroid nodules, or thyroiditis. It can also exist due to abuse of thyroid medications, such as Cytomel (T3). Underactive thyroid or hypothyroidism may be caused by inflammation of the thyroid gland, pituitary damage, too little iodine in the diet, or genetic factors, along with other possible reasons. Elevated estradiol High levels of estradiol can occur for numerous reasons, which are not limited to using certain antibiotics, some mental health medications, obesity, and abuse of exogenous testosterone. Obesity & High triglycerides While not as expected of a factor for increasing SHBG, being overweight with a low lipid profile can negatively impact. Inflammation While some level of inflammation is necessary for general health in the fight against disease or injury, what we might call chronic inflammation can lead to increases in SHBG and corresponding lower levels of free testosterone   Get Your Levels Checked: SHBG Test, Free & Total Testosterone Test   Testing your SHBG levels along with both total and free testosterone is particularly important if one wants to get to the bottom of hypogonadism (low testosterone) symptoms they may be experiencing. Remember, a total testosterone test alone, which some physicians will run, is not enough. For most adult men, SHBG levels will run between 10 nmol/L and 60 nmol/L if in the optimal range. If SHBG levels are greater than 60 nmol/L and your free testosterone is less than 2% of your total testosterone, there is a good chance your SHBG levels are too high.   Discounted Labs sells several lab test panels that measure SHBG levels that you can buy without a doctor's visit:   Testosterone (Total and Free), SHBG, CBC - Hematocrit, Ultrasensitive Estradiol and PSA   Testosterone, Free, Bioavailable and Total (Upper Limit T 1,500 ng/dL) plus SHBG   CBC, CMP, TT, FT, Lipids, Prolactin, Ultra-Sensitive Estradiol, and SHBG   Testosterone, Free, Bioavailable, and Total, LC/MS (No Upper Limit) plus SHBG   As we now understand SHBG, our next question is what can be done to lower it, increasing free testosterone in the body? There is nothing we can do about aging. As each day passes, we grow older, but there are still things we can do that will improve this factor.   How to Lower SHBG Levels:   The most obvious answer to the problem of low free testosterone and high levels of SHBG is to increase testosterone. Exercise more, consume a cleaner diet, and lose weight; all of these things will increase your testosterone levels. Your levels may not increase massively, but some increase means a higher total to pull from and a greater amount of free testosterone based on the 2% fraction. If this isn't enough - perhaps you're not reaching a 2% fraction due to elevated SHBG – one may need to consider talking to their doctor about testosterone supplementation. However, even if supplementing with exogenous testosterone, the habits mentioned are good for overall health and can only have a positive impact.   Another possible solution, and one of the more commonly needed, is lowering estradiol levels in the body. We tend to think estrogen hormones are needed for females only, but they are also crucial for men, granted in smaller amounts. As it pertains to estrogen, too much estradiol can lead to elevated levels of SHBG. If testosterone levels are also low, this can lead to even more negative factors. But it's important not to get carried away as estradiol that's too low will bring with it numerous symptoms; in fact, your life could be miserable in that regard.   Many men who are at least somewhat familiar with testosterone have been wrongly been told that too much testosterone can lead to gynecomastia due to elevated levels of estrogen in the body due to the aromatization of testosterone to estrogen. But low levels of testosterone in the body with present high levels of SHBG and estradiol can have the effect of causing gynecomastia. In order to combat high levels of estradiol, avoiding certain foods, especially those that are soy-based, will be important. Equally important is living a healthy lifestyle and incorporating what was mentioned above: adequate exercise, a healthy diet, and getting enough sleep. These things will help lower estradiol. Some men will also need medical help through medications known as aromatase inhibitors if they have gynecomastia, although most men on TRT do not need an AI. Too many men have relied on aromatase inhibitors out of fear for too many years. In reality, most men who supplement with exogenous testosterone can, in fact, control estrogen via non-medicated factors.   Some studies have shown that supplementation with DHEA (Dehydroepiandrosterone) may also lower SHBG. However, more study is needed to understand this properly, as too much DHEA can prove problematic. High doses of DHEA supplements have been associated with increased estradiol, so you must speak to your doctor first before beginning such a supplementation regimen.   Very Low SHBG :   We are then left with one factor we've yet to discuss much because it isn't all that common: low SHBG, or rather, levels of SHBG that are too low. Levels of SHBG that are too low may be an indicator of other underlying health issues. This may be an indicator of a metabolic problem. Low levels of SHBG are a standard indicator of those with diabetes. It doesn't appear, as data suggests, that insulin resistance is caused by low SHBG, but it may be a useful marker. More data is currently needed on this topic.   An A1c test will be needed to know with certainty in terms of your diabetic health.   While low SHBG is not a common concern for most men, new data has produced interesting results and information. A recent study published in the Journal of Clinical Endocrinology and Metabolism provides such information.   The process showed a man with undetectable levels of SHBG and low levels of testosterone accompanied by nearly a decade of hypogonadism symptoms. They discovered a family with a missense mutation in the SHBG gene from studying this individual. Interestingly enough, they found this issue did not interfere with the individual's spermatogenesis or general gonadal development. This leads the study to conclude SHBG may not play a significant role in the maturation of the male species physiologically or sexually.   More interesting than the JCEM study is things that new data suggest may negatively impact all men. Low levels of SHBG have recently been associated with three medical conditions that are known to be the silent killers of many men: heart disease, metabolic syndrome, and diabetes. Again, currently, it is being viewed as a marker and not as direct causation, but this new information is important as it acknowledges that more studies must be done.   Low SHBG has also been associated with:   Obesity Obesity is a factor we all well understand and is an issue that leads to problems in many health areas, and often in numerous possible directions. Cushing Disease It is associated with extended exposure to high levels of cortisol. Hypothyroidism It is associated with an under-active thyroid. Excessive levels of growth hormone Exceedingly rare for most, although possible via genetic factors or abuse of exogenous forms. Abuse through anabolic steroids     Is SHBG an Enemy of Hormone? - Emerging Studies   As we mentioned, androgens like testosterone and DHEA and estrogens are transported to the sex hormone binding globulin (SHBG). SHBG is believed to keep sex hormones inactive and to control the amount of free hormones that enter cells by passive diffusion. Contrary to the free hormone hypothesis, some researchers have demonstrated that megalin, a receptor in ovaries and testicles, acts as a pathway for cellular uptake of biologically active androgens and estrogens bound to SHBG. We will see more data on this newly found receptor that actually enables the body to use hormones bound to SHBG in the near future.   In endocrinology, the body has no “harmful” or “good” hormone. Their balance and harmony with each other matters for the best health.     References:   Ding et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. The New England Journal of Medicine. Aug 2009. Vos et al. Sex Hormone Binding Globulin Deficiency Due to a Homozygous Missense Mutation. Journal of Clinical Endocrinology and Metabolism. Sept 2014 SHBG and Free Testosterone - Everything You Need to Know Hammes et al. Role of Endocytosis in Cellular Uptake of Sex Steroids. Cell. Sept 2005  

Testosterone replacement therapy (TRT) is a medical treatment used to address low testosterone levels in men. Before initiating TRT, doctors conduct blood tests to measure total and free testosterone levels and evaluate symptoms such as low sex drive, erectile dysfunction, fatigue, low mood, and cognitive issues. Once TRT is underway, regular monitoring through blood tests is essential to ensure optimal outcomes and minimize potential side effects. This article explores the importance of blood tests in monitoring TRT, highlighting key values to consider for maximizing benefits and preventing complications. Table of Contents Blood Tests for Initial Assessment and Treatment Selection  Methods of Testosterone Replacement Therapy Follow-Up Blood Tests and Dosage Adjustments Monitoring Testosterone Levels Importance of Free Testosterone and Sex Hormone-Binding Globulin (SHBG) Monitoring Hematocrit Levels PSA Levels and Prostate Health Balancing Estradiol Levels Monitoring Blood Pressure Kidney Function (eGFR) Assessment Monitoring Liver Enzymes Thyroid Function Assessment Checking Iron Levels Monitoring HDL Cholesterol Levels Assessing Prolactin Levels Affordable Blood Testing Services and Additional Resources Conclusion Blood Tests for Initial Assessment and Treatment Selection Before initiating TRT, doctors rely on blood tests to assess testosterone levels and evaluate symptoms. Measuring total and free testosterone levels provides crucial information about hormone deficiencies. Additionally, asking patients about their symptoms helps identify possible signs of low testosterone. Based on these findings, doctors can determine the appropriate treatment approach for each individual.  Methods of Testosterone Replacement Therapy TRT can be administered using various methods, including injections, creams, gels, pellets, and nasal gels. The choice of method depends on factors such as patient preference, convenience, and specific medical considerations. The doctor's expertise is crucial in selecting the most suitable TRT option to ensure optimal results. Follow-Up Blood Tests and Dosage Adjustments Once TRT has commenced, regular follow-up blood tests are conducted around weeks six or eight. These tests help evaluate the effectiveness of the treatment and determine if any adjustments to dosage or additional medications are necessary. For instance, estradiol modulation may be required to maintain hormonal balance. Monitoring hormone levels through blood tests enables doctors to fine-tune treatment plans and ensure that patients receive the most beneficial outcomes from TRT. Monitoring Testosterone Levels Monitoring testosterone levels is a critical aspect of TRT. The target total testosterone level for men on TRT is typically above 500 nanograms per deciliter. If the measured level falls below this threshold, adjustments to dosage or injection frequency may be necessary to achieve optimal hormone balance. Importance of Free Testosterone and Sex Hormone-Binding Globulin (SHBG) Besides total testosterone, free testosterone levels are also significant. Free testosterone represents the portion of testosterone that is readily available for biological activity. Ideally, free testosterone should be around 2% of the total testosterone or higher. Lower levels may indicate issues related to sex hormone-binding globulin (SHBG), a protein that binds to testosterone and reduces its availability for use. Monitoring free testosterone levels helps doctors identify and address any SHBG-related concerns to optimize TRT outcomes. Monitoring Hematocrit Levels Hematocrit levels, which measure the proportion of red blood cells in the blood, should be monitored during TRT. Testosterone replacement can increase red blood cell count in some individuals. Elevated hematocrit levels can lead to increased blood viscosity and potential cardiovascular issues. To mitigate these risks, the ideal hematocrit range during TRT is below 53. Regular monitoring of hematocrit levels allows doctors to identify any concerns and take appropriate measures to maintain cardiovascular health. PSA Levels and Prostate Health Prostate-specific antigen (PSA) levels play a crucial role in monitoring prostate health during TRT. Men with a PSA level of four or higher require careful evaluation, as it may indicate prostate-related concerns, including the possibility of prostate cancer. Further investigation and consultation with a urologist are usually recommended for individuals with high PSA levels. Monitoring PSA levels is vital to ensuring the safe and effective administration of TRT. Balancing Estradiol Levels Estradiol, a form of estrogen, plays a significant role in men's health and well-being. Balancing estradiol levels is essential to maximizing the benefits of TRT. Very low or high estradiol levels can have negative effects on mood, cognition, cardiovascular health, sex drive, and body composition. The optimal range for estradiol levels provided by lab companies in men typically falls between 20 and 40 picograms per milliliter. However, this range does not apply to men with high testosterone blood levels caused by TRT. Regular monitoring of estradiol levels allows doctors to ensure hormonal balance and adjust treatment if necessary. Monitoring Blood Pressure Blood pressure monitoring is essential during TRT, as some men may experience increases in blood pressure due to hormonal changes. Lifestyle modifications such as weight loss, regular exercise, and medication can help manage blood pressure levels effectively. Regular blood pressure monitoring allows doctors to identify any changes and implement appropriate interventions to maintain cardiovascular health. Kidney Function (eGFR) Assessment Assessing kidney function is an important aspect of monitoring TRT. Estimated glomerular filtration rate (eGFR) is a measure used to evaluate kidney function. Contrary to common misconceptions, TRT itself does not cause a decrease in eGFR. Regular assessments of kidney function help ensure the safety and effectiveness of TRT by identifying any potential renal complications. Monitoring Liver Enzymes Liver enzyme levels, such as aspartate transaminase (AST) and alanine transaminase (ALT), should be monitored during TRT. It is important to note that TRT has not been shown to increase liver enzymes. However, men who engage in heavy weightlifting exercises may experience artificial increases in AST and ALT levels, which are unrelated to TRT or liver toxicity. Proper interpretation of liver enzyme levels is crucial to avoid unnecessary concerns or interventions. Thyroid Function Assessment Thyroid function should be monitored during TRT to ensure overall hormonal balance. Thyroid-stimulating hormone (TSH) levels are typically measured to evaluate thyroid function. A TSH level below 2.5 is indicative of a healthy thyroid. Further tests, such as measuring free triiodothyronine (T3) and free thyroxine (T4), may be conducted to assess thyroid function more comprehensively. Monitoring thyroid function allows doctors to address any thyroid-related issues that may impact TRT outcomes. Checking Iron Levels Regular monitoring of iron levels is important, particularly for individuals who frequently donate blood. Frequent blood donations can deplete iron stores, leading to fatigue and other related symptoms. To maintain optimal iron levels, individuals undergoing TRT should ensure that donation frequency aligns with recommended guidelines. If iron levels are found to be low, supplementation may be necessary to mitigate fatigue and maintain overall well-being. Monitoring HDL Cholesterol Levels High-density lipoprotein (HDL) cholesterol levels can be affected by TRT, especially at higher doses. Higher doses of testosterone replacement therapy may lead to a decrease in HDL cholesterol, which is a concern for cardiovascular health. Regular monitoring of lipid levels, including HDL cholesterol, allows doctors to assess cardiovascular risk and consider interventions such as niacin supplementation to manage HDL levels effectively. Assessing Prolactin Levels Prolactin levels are typically checked in men with very low testosterone levels or those who do not respond well to TRT. Elevated prolactin levels may indicate underlying issues that could impact the effectiveness of TRT. While prolactin is commonly associated with lactation in women, men also produce this hormone, and imbalances can lead to complications such as erectile dysfunction. Monitoring prolactin levels helps doctors ensure optimal treatment response for individuals undergoing TRT. Affordable Blood Testing Services and Additional Resources Discountedlabs.com offers affordable blood testing services, including the necessary tests for monitoring TRT labs. The website provides various blood test options, and results are typically delivered within five to seven business days. Additionally, Excel mail.com offers further information and resources on blood tests and TRT, including a blog page and a resources including a free downloadable book titled "Beyond Testosterome." These resources can help individuals educate themselves, better understand their blood test results, and make informed decisions about their TRT journey. Conclusion Monitoring TRT through regular blood tests is crucial for maximizing the benefits and preventing potential side effects. Key values to consider during blood tests include total and free testosterone levels, hematocrit levels, PSA levels, estradiol levels, blood pressure, kidney function, liver enzymes, thyroid function, iron levels, HDL cholesterol levels, and prolactin levels. Affordable blood testing services like Discountedlabs.com and resources from Excel mail.com provide individuals undergoing TRT with accessible options for monitoring their hormone levels effectively. Regular communication with healthcare professionals is vital to tailor TRT treatment and ensure its safety and efficacy. By monitoring key values through blood tests, individuals can optimize the benefits of TRT and enhance their overall well-being.            

TRT Blood Work Tests For Monitoring Men on Testosterone Therapy Before undergoing testosterone replacement therapy (TRT), it’s vital to obtain a number of blood tests, which require a blood sample. The main blood tests to measure are total and free testosterone, hematocrit, PSA, estradiol, HDL cholesterol and others. Pre-treatment testing provides doctors with baseline values to diagnose hypogonadism (low testosterone) and assess overall health. Baseline tests are also conducted during TRT as well, ensuring that doctors can adjust TRT dose and catch side effects before they become an issue. Hematocrit Test PSA Test Estradiol Test Blood Pressure Estimated Glomerular Filtration Rate eGFR Liver Enzymes Test TSH Test Free T3 Test Total Testosterone Test Free Testosterone Test Ferritin Test HDL Cholesterol Test Click here for the Pre- TRT panel and the TRT panel (after 6-8 weeks on TRT) But do you know why these tests are needed or what they mean? Below, you’ll find some of the main blood tests that have been shown to be affected by TRT, so doctors measure them before and during therapy to prevent or manage side effects: Understanding Testosterone Blood Tests A testosterone blood test is a crucial diagnostic tool used to measure the level of testosterone in your blood. Testosterone, produced by the adrenal glands and gonads (testes in men and ovaries in women), plays a vital role in the development and maintenance of male reproductive tissues, bone density, and muscle mass. This test is commonly employed to diagnose and monitor conditions related to abnormal testosterone levels, such as hypogonadism (low testosterone) and hyperandrogenism (high androgen levels). There are several types of testosterone blood tests, each serving a unique purpose. The total testosterone blood test measures the overall amount of testosterone in your blood, including both bound and free testosterone. The free testosterone test measures the testosterone that is not bound to proteins in the blood, making it readily available to the body’s tissues. Additionally, the bioavailable testosterone test measures the testosterone that is available to the body’s tissues and is not bound to sex hormone-binding globulin (SHBG). Understanding these different tests helps in accurately diagnosing and managing conditions related to testosterone levels. Why Monitor Testosterone Levels on TRT? Testosterone replacement therapy (TRT) is a medical treatment designed to increase testosterone levels in individuals with hypogonadism. Monitoring testosterone levels on TRT is essential to ensure the treatment’s effectiveness and safety. Here are some key reasons why monitoring testosterone levels on TRT is crucial: Ensuring Normal Testosterone Levels: The primary goal of TRT is to elevate testosterone levels to within the normal range. Regular monitoring helps ensure that the treatment is effective and that testosterone levels are neither too high nor too low. Adjusting Dosage: Monitoring testosterone levels allows healthcare providers to adjust the TRT dosage as needed, ensuring optimal treatment outcomes. Identifying Side Effects: TRT can cause side effects such as acne, hair loss, and mood changes. Regular monitoring helps healthcare providers identify these side effects early and adjust the treatment plan accordingly. Monitoring Long-term Effects: TRT can have long-term effects on the body, including changes in bone density and cardiovascular health. Regular monitoring helps healthcare providers track these changes and make necessary adjustments to the treatment plan. By keeping a close eye on testosterone levels, healthcare providers can ensure that TRT is both effective and safe for the patient. Hematocrit Test Hematocrit refers to the proportion or percentage of red blood cells present in your total blood volume. Your red blood cells are responsible for transporting oxygen and nutrients throughout your body. Without enough red blood cells (a condition known as anemia), your body suffers from oxygen and nutrient deprivation. On the flip side, too many red blood cells cause high hematocrit that can turn your blood into a thick slurry that can seriously affect your circulation. A normal hematocrit for an adult male is anywhere from 42 to 54%. If your hematocrit results are lower than 41%, it means you have low proportion of red blood cells. Over 55%, and you have too many. One of the primary side effects of TRT is the production of too many red blood cells, leading to high hematocrit. High hematocrit can be lowered by blood donation or therapeutic phlebotomies (ordered by your doctor if you are not allowed to donate blood at a blood bank due to exclusion criteria). Just be careful: Do not donate blood more frequently than every 2 months since this can deplete your iron stores and make you tired. This test is included in CBC (chemistries and blood count) panel.   PSA Test Prostate-specific antigen, or PSA, is a protein that is produced in your prostate gland. It's designed to liquefy semen, which is necessary for the free swimming of sperm in ejaculate. It may also help to dissolve the cervical mucus to allow the sperm to enter the uterus for the purposes of impregnation. Normal PSA levels for men under 40 range between 0 and 2 ng/mL, while PSA levels for men older may raise slowly. A PSA test helps to detect extra-high levels of this protein. High PSA levels are the result of disruptions of the cellular structure of the prostate gland, which can be caused by a number of diseases--including cancer or an infection. Benign prostate hyperplasia, urinary retention, and prostatitis can be the cause of high PSA, but your doctor will want to monitor your PSA levels just to be sure the problem isn't a serious one. If PSA levels are high, your doctor may recommend a prostate exam or even a biopsy to determine the cause of your elevated PSA levels. TRT is contraindicated for men with PSA greater or equal than 4. Estradiol Test Estradiol is the primary female sex hormone, but did you know that the male body produces it from testosterone? It is produced in fat and liver cells from testosterone via the aromatase enzyme. Due to several factors like fat content, liver disease, medication effects and genetics, some men may produce more estradiol from testosterone than other men. New information has shown that men require a special estradiol test called sensitive estradiol test. The regular test used for women may overestimate estradiol in men due to interference of inflammatory markers like C-Reactive Protein (CRP). For the average man, estradiol levels should remain lower than 50 pg/mL, although there is little evidence of what the top of the estradiol test is in men who do not have low testosterone. If estradiol levels are higher than 50 and you start showing symptoms of high estradiol (gland growth under nipples, too much water retention), it may be necessary to take an estrogen blocker (aromatase inhibitor) . However, taking aromatase inhibitor like anastrozole should be done with careful monitoring of sensitive estradiol blood test since overdosing can cause health issues in men. A few of the reported effects of low estradiol levels include: joint pain, eye fatigue, loss of erections, limited sensitivity in the penis, sleepiness, and excessive urination. Long term low estradiol can decrease bone density. A few of the reported effects of high estradiol levels (in the presence of low testosterone) include: soft erections, water retention, excessive sweating, insomnia, bloating, hot flushes, brain fog, and high blood pressure. Blood Pressure The term "blood pressure" refers to the pressure in your arteries during the beating of your heart. There are two numbers: 1) The top number, or systolic, tells you the pressure in your arteries when the muscles of your heart contract. 2) The bottom number, or diastolic, tells you the pressure in your arteries when your heart relaxes and refills with blood in the pause between heartbeats. Healthy blood pressure is lower than 120/80. If your blood pressure rises anywhere from 121/81 to 139/89, you are pre-hypertensive. Crack 140/90, and you suffer from hypertension. Anyone over 180/100 is in serious hypertensive crisis. TRT can increase water retention, sodium uptake and hematocrit is some men, factors that can increase blood pressure. If your blood pressure rises too much, it can place excess strain on your blood vessels and potentially cause a crack. Should the blood vessels crack, the resulting clotting (your body's attempt to stop internal bleeding) can interfere with healthy blood flow--potentially leading to heart attacks, strokes, peripheral arterial disease, and other cardiovascular problems. Estimated Glomerular Filtration Rate eGFR Your glomerular filtration rate (GFR) is an indication of your kidney function. The higher your GFR, the more blood passes through the glomeruli (the filters in your kidneys that remove waste from your blood) every minute. A healthy GFR is anywhere from 90 to 120 mL/min/1.73 m2. Senior citizens will often have lower GFR levels, due to the fact that kidney function decreases with age. Note: It's important to understand that each lab has its own measurements, so what is "healthy" to some may be low with others. If your GFR drops below 60 and remains at that low level for more than 3 months, it's an indication of chronic kidney disease. Liver Enzymes Test Your liver is responsible for a number of important functions, such as breaking down nutrients, producing the proteins that clot your blood, and eliminating toxins. The enzymes produced by your liver are responsible for carrying out these functions. However, if the liver suffers damage, those enzymes tend to leak into your bloodstream. High levels of liver enzymes are a good indicator that your liver has been damaged ALT and AST are the two most common liver enzymes. AST should be anywhere from 10 to 40 units per liter of blood, and ALT should be from 7 to 56 units in every liter of blood. Be aware that exercise may increase these two enzymes in a non-clinically significant way. Only oral testosterone replacement has been shown to increase liver enzymes. TSH Test Thyroid-stimulating hormone, or TSH, is a hormone produced by your pituitary glands in order to stimulate your thyroid gland to produce T3 and T4 hormones. These thyroid hormones play a role in your body's metabolic function. Normal TSH levels should be between 0.5 and 3.5 U/ml (different guidelines show different upper TSH levels). Many educated doctors test for free T3 and free T4 (the unbound thyroid hormones) when TSH is over 3 since they believe this will provide a better picture of thyroid health. If TSH levels are low, it's an indication of hyperthyroidism. If TSH levels are very high, it's an indication of hypothyroidism. Free T3 Test Free T3 refers to unbound T3 (thyroid) hormone in your bloodstream. T3 is the more important of the thyroid hormones, but it can only be produced from T4. This means your body needs to produce T4 then turn it into T3. Once the T3 is unbound from the protein molecules, it can then be used by your body to stimulate metabolic function in all your cells. Normal Free T3 levels are anywhere from 230 to 620 pg/d. If free T3 is low, your doctor may test for thyroid antibodies to ensure that you do not have an autoimmune disease called Hashimoto's. Total Testosterone Test Total testosterone test measures refer to all of the testosterone circulating in your body. Some testosterone circulates freely, while some is bound to protein molecules. The whole point of TRT is to increase your testosterone levels. A normal testosterone range is anywhere from 350 to 1070 ng/dL. Low testosterone can cause low mood, sex drive, fatigue and other symptoms. In some men, too much testosterone in the body can lead to excessive estradiol, acne, oily skin, hair loss, testicular shrinking, and increased blood viscosity due to high red blood cells. Free Testosterone Test Free testosterone refers to the testosterone circulating in your body that is NOT bound to protein molecules like albumin and sex hormone binding globulin. It is believed that your body is more easily able to use free testosterone. It usually runs at about 2 percent or higher of total testosterone. Testosterone Test Results and Interpretation Testosterone test results are typically reported in nanograms per deciliter (ng/dL). The normal range for testosterone levels varies depending on age, sex, and the laboratory performing the test. Here are some general guidelines for interpreting testosterone test results: Normal Testosterone Levels in Adult Men: 300-1,000 ng/dL Normal Testosterone Levels in Adult Women: 15-70 ng/dL Low Testosterone Levels: Less than 300 ng/dL in men or less than 15 ng/dL in women High Testosterone Levels: Greater than 1,000 ng/dL in men or greater than 70 ng/dL in women It’s important to note that testosterone levels can fluctuate throughout the day and may be influenced by various factors such as sleep, stress, and exercise. Therefore, a single testosterone test result may not provide a complete picture of an individual’s overall testosterone levels. Healthcare providers may recommend repeat testing to confirm the results and monitor changes in testosterone levels over time. Understanding your testosterone test results and their implications can help you and your healthcare provider make informed decisions about your treatment plan. Ferritin Test Ferritin is a protein that is responsible for storing iron and releasing it when your body needs to produce red blood cells. If you suffer from an iron deficiency, your ferritin level are likely to be low. Ferritin levels also fall when you give blood (a common method of lowering hematocrit). Normal ferritin levels for men is anywhere from 30 to 300 ng/mL. However, if ferritin levels are too low (after a blood donation), your body is unable to store iron, meaning it will not be able to produce new red blood cells. If you are considering donating blood to lower your hematocrit, it's a good idea to check your ferritin levels first. Your body needs enough of this protein to reproduce the red blood cells you are donating HDL Cholesterol Test High density lipoprotein, also known as HDL cholesterol, is the "good" type of cholesterol. It's responsible for counteracting the effects of low-density lipoprotein, or LDL cholesterol. Low HDL and high LDL may lead to a wide range of cardiovascular problems, including blocked arteries, stroke, heart attack, and peripheral arterial disease. According to experts, even a 5 mg/dL decrease in HDL cholesterol can increase your risk of coronary heart disease by as much as 25% Normal HDL cholesterol levels are anything above 40 mg/dL. Unfortunately, decreased HDL is a known side effect of TRT in some men using higher testosterone doses. Your doctor will monitor HDL cholesterol via a lipid panel in order to ensure that you are not at risk for heart disease. Educate yourself about testosterone replacement side effects 

Testosterone Replacement Monitoring Targets and Their Management (Consult Your Physician Before Any Treatment Initiation, Cessation or Changes). These are not absolute values and should be taken into context with symptoms. We will discuss various blood test targets for those undergoing testosterone replacement therapy (TRT). It covers key health indicators such as total and free testosterone levels, hematocrit, PSA, estradiol, blood pressure, kidney and liver function, thyroid levels, iron and ferritin levels, and cholesterol. Each parameter includes a target range and suggestions for management if the results are outside the normal range. This comprehensive approach ensures that individuals on TRT can monitor their health effectively and make informed decisions with their healthcare provider.     Total Testosterone Test above 500 ng/dL If low or hypogonadal symptoms are not improved, increase the testosterone dosage. High T levels (over 1500 ng/dL) with high hematocrit, low HDL, and/or side effects may require dosage reduction.  Free Testosterone ≥ 2 % of total T If low, test for sex hormone-binding globulin. Higher TRT dose may increase free T by decreasing SHBG. Low SHBG may be present in diabetes. Hematocrit ≤ 53 % If high, donate blood or ask your doctor for therapeutic phlebotomy order. If low, investigate anemia or stop donating blood more than every 3 months. How to Lower High Hematocrit PSA ≤ 4 ng/mL If high, talk to your doctor about potential prostatic infection or a referral to a urologist. TRT is contraindicated if PSA is 4 ng/mL or greater. Estradiol (UltraSensitive Test) = 20- ? pg/mL Most men on TRT do not need to use an aromatase inhibitor (AI). Some physicians prescribe low dose AI for what they consider high estradiol. If low, higher testosterone dose and/or cessation of AI may be required. The lab range was derived from men with heart disease and low testosterone, so there is still debate on what the range should be for men on TRT since  0.3 to 0.4 % of testosterone aromatizes to estradiol, so men with high T due to TRT will have higher estradiol.  No upper range value has been determined for men on TRT. Studies have shown that for gynecomastia to occur, high estradiol in the presence of low T and high IGF-1 may be required. Read Estradiol In Men – Why Is It Important For Optimal Health And Fitness Performance and The Top 18 Things You Did not Know About Estradiol in Men Blood pressure ≤ 135/85 mmHg If high, weight loss, exercise, T dose reduction, and/or blood pressure medications may be needed. If too low, blood pressure medication dose needs to be reduced, electrolytes checked or hypoglycemia excluded. Estimated Glomerular Filtration Rate (eGFR) (kidney function) ≥ 60 mL/min/1.73 m2 If low, good hydration, use of blood pressure medications, and/or stopping offending oral supplements may improve eGFR. Exercise, high protein intake, creatine supplements, and higher muscle mass can also increase creatinine and decrease eGFR. If under 60, explore getting a Cystatin C test. Liver enzymes ≤ 1.2 x top value of reference range If high, stopping oral supplements can help. AST and ALT can increase with exercise but this is not clinically relevant. If high AST and ALT, test GGT and bilirubin to ensure no liver toxicity is present. TSH ≤ 2.5 U/mL If high, test for other thyroid tests included in a thyroid panel like free T3, free T4, and antibodies to detect hypothyroidism. Why Only Using TSH to Diagnose Hypothyroidism is Wrong Free T3 ≥ 3.7 pg/mL If low, hypothyroidism may be present. See comment on TSH. If high (>5 pg/mL), explore hyperthyroidism. Ferritin 55-270 ng/mL & Iron 55-160 micrograms/dL If low, reduce the frequency of blood donations or phlebotomies and supplement with iron until it is back to normal. If high, donate blood or get therapeutic phlebotomy. HDL ≥ 40 mg/dL The most difficult parameter to manage. Higher TRT doses decrease HDL. Niacin may help increase HDL but may cause flushing. Prolactin ( ≤ 30 nd/dL) Test if Total Testosterone is below 150 ng/dL before TRT to detect potential pituitary adenoma or other issues. High levels (> 30 ng/dL) may cause sexual dysfunction and galactorrhea in men (milk production)     Here are panels that include these tests: Discounted Labs Panels   Buy a testosterone test on DiscountedLabs.com