Hormone health is crucial for men’s overall well-being, affecting muscle mass, energy levels, mood, and cardiovascular health.
As men age, testosterone levels may gradually decline, a process sometimes called andropause or male menopause. Unlike the abrupt hormonal changes of female menopause, andropause occurs more slowly but can still cause symptoms such as fatigue, low libido, weight gain, and cognitive changes.
Managing and optimizing hormone levels through diet, lifestyle habits, and hormone therapy is important for addressing these symptoms and promoting healthy aging.
Balanced hormones are essential for maintaining muscle mass, reducing the risk of cardiovascular disease, supporting metabolic health, and enhancing longevity. Functional medicine provides a personalized approach to assessing and treating hormone imbalances through comprehensive lab testing, helping men optimize their health as they age.
This article explores the most commonly ordered functional medicine hormone labs for men, detailing what each test includes, who can benefit from them, and how the results guide treatment.
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Testosterone Replacement Therapy: Yes or No?
Testosterone Replacement Therapy (TRT) is increasingly considered by many men and women, though it remains a topic of debate due to potential health risks associated with both high and low testosterone levels.
Current 2024 recommendations for TRT in men stress the importance of accurate diagnosis and ongoing monitoring.
TRT is typically recommended for men with two confirmed low morning testosterone levels (below 300 ng/dL) accompanied by related symptoms.
Men undergoing TRT should have their testosterone levels monitored every 6-12 months to ensure safe and effective treatment.
TRT may alleviate symptoms such as low libido, erectile dysfunction, anemia, and bone density loss. However, it carries potential risks, including polycythemia (increased red blood cells) and possible cardiovascular concerns, although evidence regarding cardiovascular risks is inconclusive.
For instance, the TRAVERSE study evaluated the safety of TRT in men aged 45 to 80 with low testosterone and heart disease risks. It found that TRT did not increase the risk of major heart problems (heart attacks, strokes, or death from heart disease) compared to a placebo over approximately 22 months. However, TRT was associated with a higher likelihood of developing blood clots in the lungs, irregular heartbeats (atrial fibrillation), and kidney issues.
Therefore, TRT should be approached cautiously in men with a history of blood clots.
Conversely, untreated low testosterone levels may be linked to higher risks of cardiovascular disease, reduced quality of life, low energy, and bone density loss, making TRT a potentially beneficial option when managed carefully.
Men aiming to preserve fertility (as TRT can reduce or eliminate fertility) and those at risk for prostate cancer should consult with a urologist or medical specialist before starting TRT.
Next, we will explore 7 specific tests that functional medicine practitioners commonly use to gain a comprehensive understanding of men's health.
1. Testosterone Testing (Total and Free Testosterone, SHBG, DHT, DHEAS)
Testosterone is fundamental to male hormone health. Low levels may result in symptoms such as fatigue, reduced muscle mass, low libido, erectile dysfunction, and depression.
Accurately assessing testosterone levels often requires more than a single blood test. Functional medicine practitioners typically recommend comprehensive male hormone testing to obtain a complete overview.
It is advisable to have testosterone blood tests conducted early in the morning, around 8 am, when levels are naturally highest.
What’s Included
Comprehensive male testosterone testing may include:
- Total Testosterone: Measures the total testosterone in the blood, including that bound to proteins like SHBG.
- Free Testosterone: Indicates the bioavailable testosterone available for use by the body.
- Sex Hormone Binding Globulin (SHBG): A protein that binds to testosterone, regulating its availability to tissues.
- Dihydrotestosterone (DHT): A more potent form of testosterone affecting male development, hair growth, and prostate health.
- DHEAS: An androgen hormone and precursor to testosterone, providing insight into adrenal function.
Additionally, estradiol levels may be assessed if there is concern about excessive conversion of testosterone to estrogen in men, a process mediated by the aromatase enzyme.
Who Can Benefit
Men experiencing symptoms of low testosterone, such as low energy, reduced muscle mass, and decreased libido, those undergoing or considering testosterone replacement therapy (TRT), or men dealing with hair loss and prostate enlargement (symptoms of high DHT) may benefit from a comprehensive testosterone panel.
How Results Guide Treatment
The results of the testosterone panel help determine androgen status and testosterone bioavailability.
- Low Free Testosterone with Normal Total Testosterone: May indicate high SHBG levels.
- High DHT Levels: Suggest excessive conversion of testosterone to DHT, its most active form.
Based on these findings, treatment options may include TRT, lifestyle modifications, or other therapies such as supplements or medications.
For instance, supplements like zinc may be recommended to lower SHBG levels. Medications or supplements that control DHT levels include 5-alpha reductase inhibitors, which block the conversion of testosterone to DHT, and saw palmetto, a natural 5-alpha reductase inhibitor.
2. Comprehensive Hormone Assessment
A comprehensive hormone assessment extends beyond testosterone, evaluating stress hormones, sex hormones, and their metabolites to provide a more detailed picture of hormonal health.
The DUTCH test (Dried Urine Test for Comprehensive Hormones) is a popular choice in functional medicine as it offers a detailed 24-hour analysis of hormone levels and their metabolites in urine.
What’s Included
Comprehensive hormone testing like the DUTCH test measures metabolites of cortisol, testosterone, estrogen, progesterone, DHEA, and melatonin over a 24-hour period using urine samples.
It also assesses dihydrotestosterone (DHT) levels and androgen metabolites, helping identify individuals who may favor the 5-alpha reductase pathway of testosterone metabolism, resulting in higher DHT production and potentially contributing to symptoms.
Who Can Benefit
Men with complex symptoms such as mood swings, stress-related hormone dysfunction, or disrupted sleep cycles may find additional insights from a comprehensive hormone assessment.
The DUTCH test also measures estrogen and its metabolites, which can indicate whether a man is converting excessive testosterone to estrogen.
This test is especially beneficial for those who have normal testosterone levels but still experience symptoms of hormonal imbalance.
When to Order Comprehensive Hormone vs. Testosterone Testing
If symptoms of hormone imbalance, such as fatigue or low libido, persist despite normal testosterone levels, a comprehensive hormone assessment can help evaluate the roles of stress, adrenal health, and other hormones in the body.
Men over 40 who are concerned about their hormone health should consider undergoing at least one comprehensive hormone assessment to obtain a complete understanding of their hormonal function.
How Results Guide Treatment
Results from a comprehensive assessment can help address adrenal function, cortisol regulation, and overall hormone balance.
Treatment plans may include stress management techniques, dietary adjustments, and supplementation with nutrients that support hormonal health, such as adaptogens for adrenal support or melatonin for sleep regulation.
Therapies to directly address testosterone levels may also be considered.
3. Cardiometabolic Panel
Men’s hormone health is closely linked to cardiovascular and metabolic health. Declining testosterone levels after age 40 are associated with an increased risk of both cardiovascular and metabolic (cardiometabolic) diseases.
Erectile dysfunction is recognized as an early predictor of cardiovascular disease. Understanding one’s cardiometabolic health status and adopting healthy diet and lifestyle habits can support heart health and may preserve sexual function.
A cardiometabolic panel evaluates key markers such as cholesterol, glucose, and inflammation to assess an individual’s cardiometabolic health status.
What’s Included
A comprehensive cardiometabolic panel typically includes markers such as cholesterol levels (total cholesterol, LDL, HDL), triglycerides, glucose, insulin, and inflammatory indicators like high-sensitivity C-reactive protein (hs-CRP).
Some practitioners may also include an advanced lipid panel to assess additional risk factors like ApoB, small dense LDL particles (sdLDL), oxidized LDL particles, and others.
Blood pressure and body composition analysis are also important components of a physical exam, as hypertension is a key symptom of metabolic syndrome.
Testosterone plays a role in preserving muscle mass; naturally declining testosterone levels can lead to changes in body composition, including reduced muscle mass and increased body fat.
Who Can Benefit
Men with risk factors for cardiovascular disease or metabolic syndrome, such as weight gain, high blood pressure, insulin resistance, and/or erectile dysfunction, may benefit from a comprehensive cardiometabolic health assessment.
Additionally, men with low testosterone or those aiming to prevent long-term metabolic issues should consider this testing.
How Results Guide Treatment
Body composition analysis helps assess muscle mass, which is closely tied to testosterone levels. Blood pressure and cholesterol results identify cardiovascular risk, especially in men with low testosterone, which can be linked to metabolic issues and heart disease.
Treatment plans may include dietary changes, exercise, sleep support, and stress management techniques.
Optimizing testosterone can also improve metabolic markers, potentially lowering the risk for heart disease and diabetes.
4. Comprehensive Gut Testing
Gut health is increasingly recognized as essential for hormone balance.
The gut microbiome plays a significant role in men's hormone health, particularly in regulating testosterone levels. It influences hormone balance by affecting the production and metabolism of testosterone and estrogen.
Beta-glucuronidase, an enzyme produced by gut bacteria, impacts estrogens and androgens like testosterone and dihydrotestosterone (DHT). This enzymatic process in the gut facilitates the reabsorption and circulation of these hormones, influencing their overall levels and activity.
Disruptions in gut health can lead to lower testosterone levels and contribute to conditions such as obesity, type 2 diabetes, and cardiovascular disease. Improving gut health through diet, probiotics, or other interventions may positively affect men's hormone balance and overall well-being.
What’s Included
Stool testing evaluates the gut microbiome, inflammation markers, digestive function, and the presence of bacteria producing beta-glucuronidase to provide a comprehensive picture of gut health.
Who Can Benefit
Men experiencing digestive issues, hormone imbalances, unexplained fatigue, or those undergoing hormone therapy, especially if they are not achieving desired or expected results, may benefit from comprehensive gut testing.
How Results Guide Treatment
Gut healing protocols, including dietary changes, antimicrobial therapies, and probiotic and prebiotic supplementation, may be considered to restore a healthy gut microbiome and support optimal hormone metabolism.
5. Thyroid Testing
Both hypothyroidism and hyperthyroidism can affect sexual function, weight, and cardiovascular health in men.
Thyroid health is essential for maintaining hormonal balance, as it regulates metabolism, energy levels, weight, and cardiometabolic health, as well as directly influencing hormone levels.
Hypothyroidism can lead to reduced free testosterone levels, hypogonadotropic hypogonadism, and sometimes elevated prolactin, all of which may improve with thyroid hormone replacement therapy. Symptoms can include erectile dysfunction.
Hyperthyroidism, on the other hand, can result in elevated testosterone, estradiol, and sex hormone-binding globulin (SHBG).
Assessing thyroid function in men is crucial for addressing hormonal imbalances and supporting overall health.
What’s Included
A comprehensive thyroid panel typically includes TSH (Thyroid-Stimulating Hormone), free T4, free T3, reverse T3, and thyroid antibodies (TPOAb, TgAb).
Who Can Benefit
Men with unexplained weight gain or loss, fatigue, mood changes, or symptoms of low testosterone may benefit from comprehensive thyroid testing
How Results Guide Treatment
Treatment may involve thyroid hormone replacement, lifestyle changes, or supplements that support thyroid health. A consultation with an endocrinologist may also be recommended.
6. Adrenal Testing
Testosterone is produced by both the testes and the adrenal glands. While the adrenal glands contribute a smaller portion of testosterone production compared to the testes, they are still vital for overall hormone balance.
Adrenal glands help regulate testosterone levels, so adrenal dysfunction can affect testosterone production.
What’s Included
Adrenal testing typically includes cortisol levels (which may include the cortisol awakening response) and DHEA measurements via saliva or urine samples. Tests are usually conducted multiple times over a 24-hour period.
Who Can Benefit
Men experiencing symptoms such as chronic fatigue, low libido, mood disorders, or poor stress tolerance may benefit from adrenal testing. Adrenal dysfunction can significantly impact testosterone levels, especially in older men, as well as overall hormone health.
How Results Guide Treatment
Treatment may include adaptogens, stress reduction techniques, and lifestyle adjustments to optimize adrenal function and balance hormones affected by chronic stress.
7. Genetic Testing for Hormone Optimization
Genetic testing provides personalized insights into how a man’s body processes hormones, detoxifies estrogen, and responds to stress. Understanding genetic predispositions can help guide interventions for optimizing hormone levels.
What’s Included
Various companies offer different genetic testing bundles. Tests relevant to men’s health include:
- MTHFR: Influences methylation processes, affecting hormone regulation and cardiovascular health in men.
- COMT: Regulates the breakdown of dopamine, estrogen, and stress hormones, impacting mood and hormonal balance.
- CYP19A1 (Aromatase): The aromatase enzyme converts testosterone into estrogen, influencing hormone balance in men.
- APOE: Associated with inflammation and cardiovascular risk, important health concerns in aging men.
Who Can Benefit
Men with unexplained hormone imbalances or those seeking a personalized approach to hormone optimization may consider genetic testing.
How Results Guide Treatment
Genetic insights help create personalized plans for hormone optimization.
For example, men with MTHFR variants may benefit from methylated B vitamins to support hormone metabolism, while those with high aromatase activity might need support to reduce estrogen conversion.
Tailored supplementation and lifestyle modifications based on genetic data can enhance hormone balance and overall health.
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Key Takeaways
- Essential Hormone Health: Hormones play a crucial role in men’s muscle mass, energy levels, mood, and cardiovascular health.
- Age-Related Testosterone Decline: As men age, testosterone levels may gradually decrease, leading to symptoms like fatigue, low libido, weight gain, and cognitive changes.
- Comprehensive Functional Testing: Functional medicine employs various lab tests—including testosterone panels, comprehensive hormone assessments, cardiometabolic panels, gut and thyroid testing, adrenal testing, and genetic testing—to identify underlying hormone imbalances and related health issues.
- Testosterone Replacement Therapy (TRT): TRT can alleviate symptoms of low testosterone but requires careful diagnosis and regular monitoring due to potential risks such as blood clots and cardiovascular concerns.
- Personalized Treatment Plans: Based on test results, treatments may include TRT, lifestyle and dietary modifications, supplements, stress management techniques, and targeted therapies to optimize hormone balance.
- Preventive and Integrated Care: Functional medicine complements conventional medical practices by focusing on prevention and addressing multiple aspects of health to support overall well-being.
- Empowerment Through Information: Comprehensive testing and personalized approaches empower men to make informed decisions, enhancing their ability to manage hormone-related changes and promote optimal health as they age.
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