The incomplete picture
Many men expect their doctors to thoroughly check hormone health when they complain of fatigue or low libido. Yet evaluations often stop at a single total testosterone test. In reality, a comprehensive hormone assessment should include free testosterone, DHEA‑S, cortisol patterns, estradiol, SHBG, thyroid markers and metabolic labs. Without these measures, important clues are missed.
Beyond the basics
The Cleveland Clinic lists several tests for diagnosing low testosterone: two morning total testosterone measurements, luteinizing hormone (LH) to see if the pituitary gland is working properly and prolactin levels to rule out pituitary disorders. Functional practitioners go further by looking at vitamin D, B12, thyroid function and even sleep patterns. They understand that low free testosterone can exist despite a normal total level, and that cortisol or nutrient deficiencies may be driving symptoms.
Case study: Alex’s missed diagnosis
Alex, 36, had normal total testosterone and was told his fatigue was unrelated to hormones. Months later, a practitioner measured his free testosterone, cortisol and DHEA‑S. Alex’s free testosterone was low and his cortisol rhythm was flat. After working on sleep hygiene, stress management and correcting nutrient deficiencies, his energy improved. A low dose of testosterone therapy further supported his recovery.
Conventional vs functional evaluation
Conventional evaluation follows guidelines that require two morning total testosterone readings and checks for pituitary problems. This is useful but may overlook free testosterone and other hormones. Functional medicine assesses the entire hormonal ecosystem, including SHBG, estradiol, thyroid and adrenal hormones. This broader perspective helps determine whether a more comprehensive approach to testosterone replacement therapy is appropriate or if lifestyle changes alone can relieve symptoms.
The takeaway
If you still feel unwell after a basic testosterone test, seek a more comprehensive evaluation. Looking at the full hormone picture often reveals hidden imbalances that standard testing misses.