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Androgen Status – Hormone Profile and Testosterone
Androgen status describes the concentration of male sex hormones in the blood. It is used to diagnose hormonal disorders in both men and women.
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Androgen status describes the concentration of male sex hormones in the blood. It is used to diagnose hormonal disorders in both men and women.
What is Androgen Status?
Androgen status is a diagnostic profile that measures the levels of androgens – male sex hormones – in the blood. Androgens are present in both men and women, but in very different concentrations. The most important androgens include testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and androstenedione. Assessing androgen status provides key insights into hormonal health and is used in endocrinology, gynecology, and urology.
Which Parameters Are Measured?
A comprehensive androgen status panel typically includes the following laboratory values:
- Total testosterone: The overall amount of testosterone in the blood, both bound and unbound.
- Free testosterone: The biologically active fraction of testosterone not bound to transport proteins.
- SHBG (sex hormone-binding globulin): A transport protein that regulates testosterone availability.
- DHEA-S (dehydroepiandrosterone sulfate): A precursor hormone produced in the adrenal cortex.
- Androstenedione: Another precursor hormone that can be converted into testosterone or estrogen.
- Dihydrotestosterone (DHT): The most potent androgen, relevant in hair loss and prostate conditions.
When Is Androgen Status Tested?
Testing androgen status is indicated in a variety of clinical scenarios:
In Men
- Suspected hypogonadism (insufficient testosterone production by the testes)
- Erectile dysfunction and reduced libido
- Infertility
- Delayed or absent puberty
- Suspected anabolic steroid misuse
- Investigation of fatigue, muscle loss, or osteoporosis
In Women
- Suspected polycystic ovary syndrome (PCOS)
- Unwanted hirsutism (excessive body or facial hair)
- Adult acne and oily skin
- Menstrual irregularities and amenorrhea (absence of menstruation)
- Suspected adrenal tumors or androgen-producing tumors
- Menopausal symptoms with reduced libido
How Is Androgen Status Determined?
Measurements are taken from a blood sample, typically drawn in the morning between 7 and 10 a.m., as testosterone follows a circadian rhythm and is at its highest in the morning. In women, the phase of the menstrual cycle is also relevant, as hormone levels fluctuate throughout the cycle. Some markers such as DHEA-S do not require fasting, while others may be more accurately measured in a fasted state.
Reference Values and Interpretation
Reference ranges for androgen status are age- and sex-dependent. Typical reference values for total testosterone are:
- Adult men: approx. 9.9 – 27.8 nmol/l (approx. 285 – 800 ng/dl)
- Premenopausal women: approx. 0.3 – 2.4 nmol/l (approx. 9 – 70 ng/dl)
Results should always be interpreted in a clinical context and alongside other parameters such as SHBG, free testosterone, LH, and FSH. Isolated abnormal values are not always clinically significant.
Treatment for Abnormal Androgen Status
Treatment depends on the underlying cause:
- Testosterone deficiency in men: Testosterone replacement therapy (e.g., gel, injection, or patch) under medical supervision.
- Androgen excess in women (e.g., in PCOS): Use of anti-androgens (e.g., spironolactone, cyproterone acetate), oral contraceptives, or metformin when insulin resistance is also present.
- Adrenal gland disorders: Specific pharmacological or surgical treatment depending on findings.
References
- Nieschlag E., Behre H.M., Nieschlag S. (Eds.) – Andrology: Male Reproductive Health and Dysfunction. Springer, 3rd Edition (2010).
- Azziz R. et al. – Polycystic Ovary Syndrome. Nature Reviews Disease Primers, 2016. PubMed PMID: 27510637.
- Bhasin S. et al. – Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 2018. DOI: 10.1210/jc.2018-00229.
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