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Low free testosterone
72 yo diabetic male with a total testosterone of 698 and a free testosterone of 4.8. I have several symptoms of low T: fatigue, ED, loss of muscle mass ( exercise several times a week), loss of body hair and concentration problems. I am not overweight. Any ideas?
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A large discrepancy in Total T and Free T can occur if patients have excess SHBG (Sex Hormone Binding Globulin). This renders the total testosterone ineffective as it is bound. Free T is considered by most to be the gold standard to determine if T is low or not. You need repeat T, Free T, LH, FSH and prolactin to look for the root cause of the low Free T (and confirm that is indeed low). Given your symptoms, if the Free T comes back low again it is very reasonable to try Testosterone or better yet, enclomiphene a pill that will raise your T levels using your own hormonal machinery (this will only work though if the FSH and LH are not already elevated).
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Dr. Kohler
Head of Mayo Mens Health Rochester, MN