Testosterone Plus is an extended health check for those who want to get a more comprehensive picture of your testosterone levels and the body's hormonal regulation. The health check includes total testosterone, biologically available testosterone as well as complementary hormones and blood markers that provide a broader basis for assessing your testosterone status.
Testosterone is the most important male sex hormone and is important for, among other things, sex drive, erectile function, muscle mass, skeleton, red blood cell production and general well-being. However, symptoms such as fatigue, decreased sex drive and impaired physical performance can have several different causes. Therefore, the test results need to be assessed together with symptoms, age, medications, lifestyle and medical background.
What is included in Testosterone Plus?
The testosterone analysis contains several relevant biomarkers that together provide a broader picture than a single testosterone test.
Total testosterone S-Testosterone
Total testosterone shows the total amount of testosterone in the blood. It includes both protein-bound and free testosterone and is usually the primary analysis when first assessing testosterone levels.
SHBG and bioactive testosterone
SHBG is a transport protein that binds a large portion of the testosterone in the blood. The level of SHBG affects the proportion of testosterone that is biologically available to the body's tissues.
By assessing total testosterone together with SHBG and albumin, a calculation of bioactive testosterone can be performed. This can provide additional information when total testosterone is close to a decision limit or when the SHBG level is unusually high or low.
Lutropin, LH
LH is a hormone produced in the pituitary gland and stimulates the testicles to produce testosterone. The combination of testosterone and LH can help assess how the body's hormonal regulation is working. Low testosterone together with elevated LH may indicate impaired testicular function. Low testosterone combined with low or normal LH may instead warrant further assessment of pituitary hormonal regulation and other possible causes.
Estradiol, S-Estradiol
Estradiol is often associated with female sex hormones, but also has important functions in men. Some of the body's testosterone is converted to estradiol by the enzyme aromatase. Therefore, the analysis can provide additional information about how testosterone is metabolized and what the balance between the sex hormones looks like. In men, estradiol is important for, among other things, skeletal strength, sexual function, fat distribution and the body's hormonal feedback. Both levels that are too high and too low can therefore be relevant to detect, especially when the symptoms are not explained by total testosterone alone.
An elevated estradiol value can, for example, occur with increased conversion of testosterone to estradiol, which can be seen in cases of obesity, certain liver diseases or treatment that affects the sex hormones. A low value can, for example, occur with low testosterone production or when using drugs that inhibit aromatase.
In men, the estradiol concentration is usually below approximately 150 pmol/L. The reference interval may vary slightly between different laboratories, and the test result should therefore always be assessed based on the interval stated in the analysis result. An elevated or low value also needs to be interpreted together with testosterone, SHBG, LH, symptoms and medical background.
Analysis of s-estradiol is particularly relevant in cases of breast tenderness or breast development, impaired sexual function, fertility problems or when following up on testosterone treatment. Estradiol should always be assessed together with total testosterone, SHBG, LH, symptoms and medical background.
Prolactin
Prolactin is a hormone produced in the pituitary gland and is important for the body's hormonal regulation. In men, an elevated prolactin level can inhibit signaling between the pituitary gland and the testicles, which in turn can contribute to reduced testosterone production. The analysis is particularly relevant for symptoms such as decreased sex drive, erection difficulties, fertility problems or low testosterone levels in combination with a low or normal LH value. Prolactin can therefore provide important supplementary information about whether a possible testosterone deficiency may be linked to central hormonal regulation.
An elevated prolactin value needs to be assessed together with other hormone values, symptoms, medications and medical history. Prolactin can be temporarily affected by, among other things, stress, sleep, physical activity and certain medications, which means that a deviating result sometimes needs to be checked with a new sample.
Blood status
Blood status includes, among other things, hemoglobin, red and white blood cells and platelets. The analysis can identify, for example, anemia and other abnormalities that may contribute to fatigue or decreased energy. Hemoglobin and hematocrit are also important in monitoring testosterone therapy, as the treatment can increase the production of red blood cells.
When might an extended testosterone test be relevant?
Testosterone Plus may be relevant for men who experience symptoms that may be consistent with low testosterone levels or who want to follow up on a previously abnormal testosterone value.
Examples of symptoms and situations where testing may be considered are:
- decreased sex drive
- fewer spontaneous morning erections
- erectile difficulties
- decreased muscle mass or muscle strength
- pronounced fatigue or reduced energy
- reduced physical performance
- depressed mood or reduced motivation
- difficulty concentrating
- infertility or reduced reproductive capacity
- previously low or difficult-to-interpret testosterone values
- follow-up of ongoing testosterone treatment
Several of these symptoms are non-specific and can also occur in cases such as lack of sleep, stress, depression, obesity, thyroid disorders, chronic illness or drug treatment. A testosterone test can therefore provide important information, but the result always needs to be assessed as part of a larger whole.
How are testosterone values interpreted?
The testosterone value is assessed based on the laboratory's reference interval, sampling time, symptoms and other hormone results. A single low value is not sufficient to determine testosterone deficiency. In the case of a low or borderline result, it is usually recommended that total testosterone be checked again on a separate occasion. The diagnosis of testosterone deficiency normally requires both relevant symptoms and repeated low testosterone values.
Total testosterone and SHBG need to be assessed together
The majority of testosterone in the blood is bound to SHBG or albumin, while only a small proportion circulates completely freely. Changes in SHBG can therefore affect total testosterone without the amount of biologically available testosterone changing correspondingly. SHBG can be affected by, among other things, age, body weight, liver function, thyroid function, medications and hormonal conditions. In the case of a difficult-to-interpret total testosterone, an estimate of biologically available testosterone can therefore provide supplementary information.
What does the combination of testosterone and LH show?
Testosterone and LH can together provide guidance as to where in the hormonal system a possible disorder may be located. Low testosterone in combination with high LH may indicate that the testicles are not responding normally to stimulation. Low testosterone together with low or normal LH may instead be consistent with reduced stimulation from the pituitary gland or with functional effects such as illness, obesity or certain medications.
The result alone cannot determine the cause, but can show whether further hormonal or medical investigation is warranted.
Testosterone changes during the day
Testosterone levels follow a circadian rhythm and are usually highest in the morning. In order for the result to be as comparable and reliable as possible, men are recommended to submit the test between 7:00 and 10:00. Food intake can temporarily lower testosterone levels. You should therefore fast before the test and avoid eating from 10:00 pm the evening before the test. Water is fine to drink.
Hard physical exercise, acute illness, lack of sleep and high alcohol consumption can also affect hormone values. It is therefore advisable to avoid intense exercise and alcohol the day before the test and not to submit the test during an ongoing acute illness if the analysis can wait.
Can the test diagnose testosterone deficiency?
Testosterone Plus provides a broad picture of testosterone levels and the body's hormonal regulation. However, the health check cannot establish a diagnosis alone, since testosterone deficiency is assessed based on a combination of relevant symptoms, repeated hormone tests and a medical assessment.
A doctor's report is always included if you wish. If your test results indicate testosterone deficiency and you are also experiencing symptoms that may be compatible with hypogonadism, we also offer a free consultation with a doctor to review the results and assess any further investigation.
In the event of very low testosterone concentrations or other deviating results, further analyses may be needed, such as prolactin, FSH, TSH, free T4, liver tests or other examinations depending on the symptoms and test results. Do not start testosterone treatment or use of hormone preparations based solely on a single test result. Testosterone treatment always requires medical assessment and follow-up and can also reduce the body's sperm production and affect fertility.
