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Testosterone Replacement Therapy: Why Monitoring is Important (Part 2)

by Cecilia Lodi on July 13, 2023

In the first part of this article, we discussed the significance of periodic monitoring during testosterone treatment. In part 2 of this article series, we continue to enumerate specific laboratory tests that need to be checked regularly and why they are essential in the safe, and optimal management of your hormone replacement therapy. If you are currently on a Testosterone treatment protocol or planning to receive one in the future, you need to at least be familiar with the following blood work.


Lipid Profile

We mentioned in the first part that lowering of HDL-Cholesterol during TRT may increase the risk of coronary heart disease. This, however, is only one component of your lipid panel and should be interpreted in relation to other blood tests, such as:

Total Cholesterol- Normal levels should be less than 200 mg/dL. Anything above 240 may require lifestyle and dietary changes and if values remain to be high, your doctor may prescribe you a trial of Statins or other cholesterol-lowering medications.

LDL-Cholesterol- The goal is to maintain levels at 130 mg/dL and below. The concentration of low-density lipoprotein (LDL) cholesterol has been the primary indicator of cardiovascular disease risk and the primary target for treatment.

LDL/HDL Ratio- The optimal ratio is between .5 to 3. Because LDL is "bad" and HDL is "good," having a lower LDL/HDL cholesterol ratio is preferable. High LDL levels have been linked to heart and blood vessel damage and disease. HDL, on the other hand, has been shown to protect against this injury.

Triglycerides- High triglyceride levels may give rise to artery hardening or thickening (arteriosclerosis), which raises the risk of stroke, heart attack, and cardiovascular disease. Extremely high triglycerides can also cause acute pancreatic inflammation known as pancreatitis. It is recommended to maintain your triglycerides below 150 mg/dL

ApoB- Apolipoprotein B-100 (ApoB) is a protein that helps carry fat and cholesterol through your body and a component of all atherogenic particles, including very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), LDL, and lipoprotein(a) - each particle contains 1 molecule of apo B. Therefore, apo B provides a direct measure of the plaque-promoting particles in the circulation.
Lipoprotein(a)- The top reason for evaluating patients for Lp(a) is to help identify those who are at high risk for heart disease, — particularly if other major risk factors are not present. It also aids in the identification of patients who may require more intensive lipid therapy. Ideal levels should be below 30mg/dL.




Liver Function

While many studies suggest that long-term testosterone therapy improves liver function in hypogonadal men, previous research which indicated there was a link between testosterone therapy and hepatocellular carcinoma may have been exaggerated. Many clinicians are still unsure about the nature of hormone therapy in relation to liver disease, hence the importance of monitoring liver enzymes.

AST- Normal units are between 8-40 per liter. A high AST level may suggest damage in the liver or other organs that produce it, such as the heart or the kidneys. For this reason, clinicians frequently combine the AST test with assessments of other liver enzymes such as ALT, Alkaline Phosphatase and GGT.

ALT- The 5-fold upper limit of the normal range (40 U/L) for ALT is the cut-off point for drug-induced liver damage (or 3-fold if total bilirubin exceeds its normal range by 2-fold). Intense physical training can cause an ALT increase of five times. Your physician can tell whether elevated enzyme levels are a normal reaction to exercise or a sign of liver damage by corelating it to GGT.

Total Bilirubin- Bilirubin is an orange-yellow pigment which naturally occurs when red blood cells break down. It is used to aid in the diagnosis of diseases such as liver disease, anaemia, and jaundice. Doctors use it to diagnose and track cirrhosis, hepatitis, gallstones, hemolytic anaemia, and other liver and bile duct disorders in both children and adults.

γ-Glutamyl Transferase (GGT)- When there is liver injury, GGT may leak into the bloodstream. High levels of GGT in the blood could indicate liver damage or bile duct disease. A GGT level exceeding 50 IU often doesn't indicate anything serious. Talk to your doctor right once if your test result is high (above 100 IU).



Kidney Function

Recent research demonstrates that in hypogonadal males, long-term testosterone therapy mostly improves their metabolic characteristics. Long-term testosterone therapy results in an increase in GFR, which enhances kidney function. However, some cases observed a rise in creatinine during testosterone therapy, which can signify physiology or pathology.
Creatinine- Creatinine is a waste product made by your muscles and results of a creatinine test indicate how well your kidneys are removing waste from your blood. To confirm a kidney problem, it is frequently ordered with blood urea nitrogen (BUN) and eGFR. The ideal range is 1.3 mg/dL or below.

BUN- A blood urea nitrogen (BUN) test detects the amount of nitrogen in your blood that comes from urea, the waste material formed when protein is degraded in your body. Your BUN level increases if your kidneys are unable to eliminate urea from the blood as they should. Your BUN level may be greater than the normal range (6-24 mg/dL) due to heart failure, dehydration, or a high-protein diet. Your BUN level may decrease due to liver illness or injury.
eGFR- The glomerular filtration rate (GFR) test estimates how well your kidneys are removing waste from your body through its filtration system called the glomeruli. A GFR of above 90 is regarded as ideal for the majority of individuals. If your GFR is less than 60, you may have renal disease.

On the third part of this article series, we will talk about the importance of assessing thyroid and iron levels, as well as gonadotropins, sex hormones and neurosteroids during Testosterone therapy.