I. Introduction

Around 10% to 40% of men around the world have a testosterone deficiency, and more than 18 million American men over the age of 20 have erectile dysfunction.

This guide explains the importance of the testosterone and estradiol tests for men, including why the tests should be performed, what the testing process entails, and how long it takes to get the test results. The guide also includes information on erectile dysfunction, which can occur in men with low levels of testosterone or high levels of estradiol.

II. Overview of Men's Hormone Testing

The purpose of men’s hormone testing is to determine if a man has a hormonal imbalance that might affect his mood or reproductive health. Total testosterone is one of the most common hormone tests performed in men. This test checks for three types of testosterone in the blood: free testosterone, testosterone bound to sex hormone binding globulin (SHBG), and testosterone bound to a protein called albumin. The estradiol test checks to determine if a man has too much or too little estradiol in his body. Estradiol, a form of estrogen, is produced in the testes.

Testosterone testing should be done under the following circumstances:

  • If a man is experiencing erectile dysfunction or a loss of libido
  • When a man has signs of low testosterone, such as trouble achieving an erection
  • Any time a man experiences a loss of muscle mass

Subsequent tests to monitor treatment of a diagnosis of low testosterone (“low T”) may also be required three and six months after the beginning of treatment.

Estradiol testing should be done in the following circumstances:

  • If a man has developed female characteristics, such as the growth of excess breast tissue
  • When a boy experiences delayed puberty

The total testosterone test is performed on a blood sample, while the estradiol test can be performed on a sample of blood, saliva, or urine. No special preparation is required for either test.

III. The Basics of Erectile Dysfunction

Erectile dysfunction (ED)  is a condition in which a man has trouble achieving or maintaining an erection. Even healthy men sometimes have trouble achieving an erection firm enough for intercourse; what sets erectile dysfunction apart is that it causes persistent difficulties. ED can result in a loss of confidence and interfere with or stress romantic relationships..

Erectile dysfunction has several causes, including abnormal levels of testosterone or estradiol. In some men, damage to the blood vessels prevents enough blood from collecting in the penis, resulting in an inability to achieve an erection. Vascular damage has many causes, including heart disease, diabetes, high blood pressure, and chronic kidney disease. Nerve damage can also result in erectile dysfunction. Diabetes, multiple sclerosis, spinal cord injuries, and surgery on the prostate or bladder are some of the potential causes of nerve damage that can lead to ED. In some cases, medications taken to control another medical condition can cause a man to develop erectile dysfunction. These medications include antidepressants, medications used to treat high blood pressure, tranquilizers, sedatives, medications used to control appetite, and medicines used to treat prostate cancer.

Although many medical conditions can cause erectile dysfunction, ED can also develop due to stress and other psychological issues. Depression, anxiety, low self-esteem, and fear of sexual failure are all potential causes of erectile dysfunction. Finally, certain lifestyle factors may increase the risk for erectile dysfunction, including weight problems, lack of physical activity, excessive alcohol consumption, tobacco use, and use of illicit drugs.

The main symptom of erectile dysfunction is an inability to achieve or maintain an erection. In some men, the problem is intermittent. They may be able to get an erection sometimes, but not every time they want to have one. Some men are able to achieve erection consistently, but they cannot maintain an erection long enough to have sexual intercourse. In severe cases, a man with erectile dysfunction cannot achieve an erection at all.

IV. How Men's Hormone Testing Works

Men’s hormone testing is used to check for hormonal imbalances that can cause ED and other medical problems. Two of the most common hormone tests for men are the total testosterone test and the estradiol test. Only a blood sample can be used for the total testosterone test, but the estradiol test can be performed on blood, urine, or saliva.

Blood Testing

For a blood test, a sample of the man’s blood is collected by a phlebotomist. Before drawing a blood sample, the phlebotomist uses a tourniquet to prevent the blood in the lower arm from returning to the heart. This causes the veins to swell slightly, which makes them easier to see. Once a suitable vein has been identified, the phlebotomist cleanses the skin thoroughly to prevent bacteria from entering the patient’s bloodstream when the needle pierces the vein. After inserting the needle, the phlebotomist uses a small container to collect blood.

Urine Testing

Urine estradiol testing typically requires the patient to collect his urine at home for a period of 24 hours. To ensure an accurate result, a man should adhere to the following procedure when doing the collection:

  • Urinate into the toilet upon waking up in the morning.
  • For the next 24 hours, collect all urine in a large container provided by the laboratory. If a man has trouble urinating directly into the opening, he can urinate into a specimen container with a wider mouth and then transfer the urine to the large container.
  • Return the sample to the laboratory or doctor’s office.

The container of urine must be kept in the refrigerator for the entire collection period.

Saliva Testing

For added privacy, home testing kits are available for men who need to have their estradiol levels checked. These test kits contain all the supplies needed to provide a saliva sample. Since the collection instructions vary from one provider to another, the saliva sample should be collected according to the instructions that come with the kit.

V. Treatment for Erectile Dysfunction

Treatment options for erectile dysfunction range from lifestyle changes to medications. Because ED has many causes, it’s important for any man with erectile dysfunction to seek advice from a qualified medical professional. The National Institute of Diabetes and Digestive and Kidney Diseases recommends lifestyle changes such as stopping tobacco use, reducing alcohol consumption, increasing physical activity, and stopping any illicit drug use. Losing weight, if necessary, or maintaining a healthy weight can also help with erectile dysfunction.

If erectile dysfunction is caused by medication, trying a different medication may help. However, men with erectile dysfunction should not stop taking their medications without talking to a doctor first. Under the supervision of a medical professional, it may be possible to find an alternative medication that does not make it difficult to achieve or maintain an erection. For men who have ED due to high levels of stress or other psychological problems, counseling may help reduce anxiety levels enough to achieve and maintain an erection.

Several medications are available to treat erectile dysfunction, including sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Each medication increases blood flow to the penis, which makes it easier for a man to achieve an erection when he is sexually stimulated. A man with erectile dysfunction should not take one of these medications without consulting a doctor, as it is possible for an ED medication to interact with some of the medications used to treat heart conditions, which can cause a dangerous drop in blood pressure.

VI. Frequently Asked Questions

What is the difference between the total testosterone test and the free testosterone test?

Much of the testosterone in a man’s body is bound to proteins. These proteins are known as albumin and sex hormone binding globulin. Only a small amount of testosterone circulates freely; this is known as free testosterone. The free testosterone test only checks for this small amount of unattached testosterone. In contrast, the total testosterone test checks for free testosterone and bound testosterone, giving the ordering physician a clearer picture of the patient’s health.

Estradiol is a type of estrogen. Isn’t that a female hormone?

Women do have more estrogen in their bodies than men, but estradiol plays an important role in a man’s sexual development and ability to reproduce. In men, estradiol is involved in the production of sperm, regulation of the sex drive, and the ability to achieve and maintain an erection. Too much estradiol makes it difficult to achieve an erection, reduces sperm production, and causes the testes to get smaller. Therefore, it’s important for men to have their estradiol tested if they have any symptoms of ED or another hormonal imbalance.

Isn’t erectile dysfunction something that only occurs in elderly men?

The condition is more common in older men, but it also affects young and middle-aged men. Because erectile dysfunction has so many potential causes, it’s important for any man with the symptoms of ED to consult a medical professional. A licensed professional can perform a physical exam and order appropriate tests, including the total testosterone test or the estradiol test, to determine the underlying cause of the condition.

Does it matter what time of day a man has his testosterone levels checked?

A man’s testosterone levels are at their highest first thing in the morning. Testosterone levels fluctuate daily, so it may even be necessary to have multiple testosterone tests done to determine if a man’s testosterone level is actually low. Some doctors recommend early-morning testing, when testosterone levels are highest, to get the most accurate results.

How is the testosterone test used?

In addition to helping medical professionals determine the cause of a man’s erectile dysfunction, the testosterone test can be used to diagnose many conditions related to the male reproductive system. These conditions include delayed puberty, early-onset puberty, and male infertility. The testosterone test is also used in the investigation of testicular tumors, problems with the pituitary gland, and conditions affecting the hypothalamus, which helps regulate sleep patterns and emotions.

Why should men have their testosterone tested instead of just taking testosterone supplements if they feel they have a hormone deficiency?

It’s important to have a medical professional conduct a physical examination and order appropriate tests based on age, medical status, and other factors. Just because a man has erectile dysfunction or another symptom of a hormonal imbalance does not mean he definitely has low testosterone or high estradiol levels. ED can be caused by a variety of medical conditions, some of which can be life-threatening without proper treatment.

Testosterone supplements can also have dangerous side effects, especially in men who have a history of stroke and heart attack. Even if a man has low testosterone, it’s important that he discuss the benefits and risks of testosterone therapy with a doctor to ensure he makes an informed choice. Possible side effects of testosterone supplements include acne, difficulty breathing while sleeping, swelling of the breasts, and swelling of the ankles.

VII. Additional Resources

To learn more about testosterone and estradiol tests for men, including why the tests should be performed, use the following resources.

MedicineNet Information on high and low testosterone levels in men, including symptoms and treatment.
Urology Care Foundation Information on erectile dysfunction, including symptoms, causes, and treatment.
U.S. National Library of Medicine Information on testosterone level testing, including what it’s used for and what happens during level tests.

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