Testosterone Therapy in Australia
Accessing it isn’t easy, and that’s a good thing.
I’ve heard stories of patients walking into clinics in the United States who are able to get prescribed Testosterone Replacement Therapy (TRT) on the day without thorough investigation. This is bad medicine and a misuse of testerone as a medication. There is increased knowledge amongst the general male population about Low Testosterone & TRT from social media, forums and books.
This has both positive and negative aspects to it. On the positive side, it is important for men that are suffering from potential symptoms of low testosterone to get their testosterone levels tested, and with this increased awareness comes increased testing. And we know that testosterone levels, and sperm counts are increasing across the globe for a number of reasons. (e.g. obesity, stress, alcohol, environmental estrogens etc) On the negative side, not everyone who has fatigue or low libido has low testosterone but patients may have a preconceived role in their minds of what testosterone can do for them. There is increasing pressure amongst men to perform at a high level in their stressful jobs, attain an adonis physique and then have energy left over to be an amazing father and men are more aware then ever of the help that science can bring to this ideal. This ideal of “the perfect man”, can then lend itself to seek pharmacological help when, perhaps, psychological or other forms of help can be better suited.
Nonetheless, low testosterone can be debilitating for men and I see lot’s of it in my clinic.
Symptoms of Low Testosterone
When a patient comes into my clinic concerned about:
Fatigue
Low libido
Mood changes or increased irritability
Or any non-specific symptoms
Initial Testing & Diagnosis
I ask them to do an ADAM QUESTIONNAIRE. (See Right: ADAM stands for Androgen Deficiency in the Aging Male.) If they score high enough on the ADAM Questionnaire then it is reasonable to do a blood test to investigate for testosterone deficiency, which is also called male hypogonadism. I will usually also look for some other biomarkers as part of blood test to look for other causes of these symptoms like hypothyroidism, vitamin deficiences, liver issues, etc.
Firstly, and when we do the initial testing for low testosterone, it is important to look at both total testosterone and free testosterone. Total testosterone is the total amount of testosterone in the blood. Some of this testosterone will bind to albumin, a protein in the body, and then will become inert or inactive. Free testosterone is the testosterone that is active, and not bound to albumin, that is then “free” to exert its anabolic and androgenic effect on the cells of the body.
I find that some patients can have symptoms of low testosterone but then can have testosterone levels on the low side of normal but then when we test their free testosterone, it may be low. This helps us look at their overall sympom presentation and compare it to their biochemical presentation.
If Levels are Low On Initial Testing
If Levels are Normal
Secondly, if they have a low testosterone level, we are
