Men's Health Tests — Testosterone, PSA & Beyond

Testosterone is the primary male sex hormone, but its role extends far beyond reproduction:

• Muscle mass and strength maintenance

• Bone density (low testosterone leads to osteoporosis in men)

• Red blood cell production

• Mood regulation and cognitive function

• Energy levels and motivation

Normal ranges::

• Total testosterone: 300–1000 ng/dL (adult men)

• Free testosterone: 8.7–25 pg/mL

Why levels fall:: Natural aging accounts for ~1% annual decline after age 30. However, obesity, chronic stress, poor sleep, and metabolic syndrome can accelerate decline significantly.

PSA (Prostate-Specific Antigen): is a protein produced by prostate gland cells. Elevated PSA levels can indicate:

• Prostate cancer (malignant)

• Benign Prostatic Hyperplasia (BPH) — non-cancerous enlargement

• Prostatitis (prostate infection/inflammation)

PSA reference ranges::

• < 4 ng/mL: Generally normal

• 4–10 ng/mL: Grey zone — further evaluation needed

• > 10 ng/mL: High suspicion for cancer; biopsy often recommended

Important caveats:: PSA can be elevated by vigorous exercise, ejaculation, or prostate infection. Levels should be interpreted with a digital rectal examination (DRE) and age-adjusted norms.

Free PSA ratio:: When total PSA is borderline, the ratio of free-to-total PSA helps distinguish BPH (higher ratio) from cancer (lower ratio).

SHBG (Sex Hormone-Binding Globulin):: Protein that binds to testosterone, making it inactive. High SHBG means less free (active) testosterone even if total testosterone is normal.

LH (Luteinising Hormone) & FSH:: Pituitary hormones that signal the testes to produce testosterone and sperm. Abnormal levels help locate whether the problem is in the testes (primary) or the brain's pituitary axis (secondary).

Prolactin:: Elevated prolactin in men causes reduced testosterone, low libido, and can indicate a pituitary adenoma.

Semen Analysis:: The definitive test for male fertility assessment — sperm count, motility, and morphology.

HbA1c & Lipid Panel:: Diabetes and cardiovascular disease are strongly correlated with low testosterone — these tests should always accompany a men's hormone panel.

• **Age 40+:** Annual checkup recommended; PSA baseline recommended from 45 (or 40 if family history of prostate cancer)

• **Symptoms of low testosterone:** Fatigue, reduced libido, muscle loss, mood changes, difficulty concentrating

• **Infertility concerns:** Semen analysis + hormonal panel

• **Obesity:** Strongly associated with low testosterone and elevated oestrogen

• **Erectile dysfunction:** Can be a vascular and hormonal issue — a full metabolic + hormonal panel gives clarity