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Suggest treatment for erectile dysfunction

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Posted on Wed, 16 Dec 2015
Question: Hi
Doctor
My free testosterone is 54pmol/l
And the ranges are from 25-120 pmol/
This is done in Australia
I am 32 yes of age and think this is low for my age and might be giving me some ED issues.
What do you think?
doctor
Answered by Dr. Shehzad Topiwala (28 minutes later)
Brief Answer:
Free Testosterone

Detailed Answer:
Sorry to note your ED problem.

The units reported by your laboratory for free testosterone are not conventional. It is usually in ng/dl format.

Although it still appears to be within range, there are many caveats to be considered before this reading can be taken into account as an accurate reflection of your blood free testosterone levels.

Firstly, the best way to measure Free Testosterone is called Equilibrium Dialysis. This is a special technique which is not routinely available. However some labs do use this. SO it is highly recommended that you ask your lab whether or not they used this method to analyze your blood for Free Testosterone levels.

Other methods are notoriously unreliable and inaccurate.

2 For this reason, Free testosterone can be indirectly calculated using

Total Testosterone
SHBG (Sex Hormone Binding Globulin)
Albumin

These are three blood tests. There are online free calculators available to estimate the Free Testosterone from these three values. This result is more closer to the reading one gets by measuring Free Testosterone using Equilibrium Dialysis method.

3 Thirdly, testosterone levels are supposed to be measured in the morning time preferably closer to 9 am. This is because the levels normally decline as the day progresses. SO if you were to have a blood sample taken in the afternoon it would probably be low and one would misinterpret that as having an abnormal reading when that is not the case.


When I see someone like you in my practice, I typically order the following tests in addition to a detailed physical examination:

CBC
Electrolytes
Calcium
HbA1c
Liver function tests
Kidney function tests
TSH
25 hydroxy Vitamin D
Total Testosterone
SHBG (Sex Hormone Binding Globulin)
Albumin
Prolactin
Ferritin
FSH
LH


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (1 hour later)
Well yes my free testosterone was 54.5pmol/L
And normal range was 25.0-120pmol/L
This was done in Australia 4 days ago and orderd by doctor.
Not sure what you think?
These are the ranges they used.
doctor
Answered by Dr. Shehzad Topiwala (45 minutes later)
Brief Answer:
Follow up

Detailed Answer:
Yes I did review those results and my suggestion to you is to go to them and ask them if they used Equilibrium dialysis as the method.

Moreover, guidelines emphasize that a low testosterone level must be reconfirmed on a second occasion befoRe proceeding further with more tests.

So in any case, a repeat blood draw is in order. I would do the above mentioned tests to know with reasonable certainty whether or not you truly have low testosterone levels or not.
The free testosterone test that you have undergone has limitations as I have explained to you here.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Suggest treatment for erectile dysfunction

Brief Answer: Free Testosterone Detailed Answer: Sorry to note your ED problem. The units reported by your laboratory for free testosterone are not conventional. It is usually in ng/dl format. Although it still appears to be within range, there are many caveats to be considered before this reading can be taken into account as an accurate reflection of your blood free testosterone levels. Firstly, the best way to measure Free Testosterone is called Equilibrium Dialysis. This is a special technique which is not routinely available. However some labs do use this. SO it is highly recommended that you ask your lab whether or not they used this method to analyze your blood for Free Testosterone levels. Other methods are notoriously unreliable and inaccurate. 2 For this reason, Free testosterone can be indirectly calculated using Total Testosterone SHBG (Sex Hormone Binding Globulin) Albumin These are three blood tests. There are online free calculators available to estimate the Free Testosterone from these three values. This result is more closer to the reading one gets by measuring Free Testosterone using Equilibrium Dialysis method. 3 Thirdly, testosterone levels are supposed to be measured in the morning time preferably closer to 9 am. This is because the levels normally decline as the day progresses. SO if you were to have a blood sample taken in the afternoon it would probably be low and one would misinterpret that as having an abnormal reading when that is not the case. When I see someone like you in my practice, I typically order the following tests in addition to a detailed physical examination: CBC Electrolytes Calcium HbA1c Liver function tests Kidney function tests TSH 25 hydroxy Vitamin D Total Testosterone SHBG (Sex Hormone Binding Globulin) Albumin Prolactin Ferritin FSH LH