What are the early warning indicators of male hormone health risks?

Currently, the clinically recognized core indicators of male hormone health risk warning are based on serum total testosterone, free testosterone, and sex hormone binding globulin (SHBG), together with luteinizing hormone, follicle-stimulating hormone, prolactin secreted by the pituitary gland, and estradiol, which can basically cover more than 90% of abnormal screening needs. Last week, I met a 34-year-old game planner in the clinic. He has been working on projects for more than half a year. Recently, he has been feeling unmotivated. He can't even climb up to the third floor without breathing, and his married life is always out of shape. He bought a lot of kidney-tonifying supplements and took them for two months, but they have no effect. When he came for a check-up, the total testosterone was only 272ng/dl, and the free testosterone was less than 60% of the lower limit of normal. It is already a typical early stage of late-onset hypogonadism.

Some people may say that I have checked six hormones before and my total testosterone is within the normal range. Why do I still have these symptoms? This brings up the controversy over the critical value that has not yet been fully unified in the industry. Many European and American guidelines regard 300ng/dl as the abnormal critical value of total testosterone. However, many domestic clinicians will adjust it based on age. For example, for young men around 25 years old, if total testosterone is less than 350ng/dl, even if it is stuck at the so-called lower limit of normal, it is actually a risk warning, and a unified standard cannot be rigidly applied. And there is another indicator that is easily overlooked here, which is sex hormone binding globulin. You can think of it as the "exclusive transport vehicle" of testosterone. If the value of this protein is high, most of the testosterone will be tied to the vehicle and cannot be directly used by body organs. Even if the total testosterone value is good, the free testosterone that can really work is not enough. There will be no shortage of symptoms of fatigue and lack of interest. At least 30% of the patients in my clinic have fallen into the trap of "just looking at total testosterone and thinking there is no problem."

In addition to these direct hormonal indicators, more and more endocrinologists now also include metabolic indicators in the early warning system for hormonal risks. For example, if an adult male's abdominal circumference exceeds 90cm, his fasting triglyceride exceeds 1.7mmol/L, and his fasting blood sugar is high, even if the current hormone values ​​are within the normal range, the risk of testosterone decline in the next three years is more than three times higher than that of ordinary people. To put it bluntly, obesity and metabolic syndrome are "invisible killers" of male hormone secretion. The layer of fat on the belly secretly converts testosterone into estradiol, dragging down the entire hormonal balance.

There is a popular saying on the Internet that acne and androgenic alopecia must be caused by too high testosterone. In fact, this is quite controversial. Many patients with androgenic alopecia have found that their testosterone is within the normal range, but their hair follicles are more sensitive to dihydrotestosterone than ordinary people. If you rush to use androgenic products, it will easily disrupt your own hormone secretion rhythm, which is not worth the gain. If you have poor sleep, rapid muscle loss, inexplicable belly fat, easy irritability and low mood, and a significant decline in the quality of your sexual life for two or three months in a row, don’t force yourself to do it and don’t buy health supplements blindly. Find a weekday between 9 and 11 a.m. to get a blood draw. You don’t have to fast. Check all the indicators mentioned above. It’s much more reliable than guessing by yourself.