Also available today: A full lesson on lipoprotein(a).
 

After reviewing the case answer, explore FMU’s professional recognition, credential requirements, and a full lipoprotein(a) lesson taught by Thomas Dayspring, MD, FACP, FNLA.

Two low morning testosterone results. A patient who wants his energy back. Would you recommend replacement?

One finding could change your interpretation.

The Case

A 49-year-old man reports fatigue, difficulty concentrating, and increasing abdominal weight gain.

“My testosterone is low on two tests. Isn’t that why I feel this way?”

Both samples were collected fasting at approximately 8 a.m. on separate mornings, when he was not acutely ill.

• Total testosterone: 248 and 261 ng/dL—both flagged low.
• SHBG: Below the laboratory’s reference range.
• Free testosterone: Within range on both samples, measured by equilibrium dialysis.
• BMI: 34.
• Hemoglobin A1c: 6.2%.

His libido and morning erections are unchanged. He sleeps approximately five hours nightly.

Which Is the Best Next Step?

A. Coordinate testosterone replacement because his symptoms and two low morning total testosterone results establish the need for treatment.

B. Interpret total testosterone alongside SHBG, reliably measured free testosterone, and his symptom pattern; evaluate other contributors to fatigue before deciding whether replacement is indicated.

C. Exclude a hormonal contribution because free testosterone is normal, and begin a weight-loss plan without further evaluation of his fatigue.

Choose your answer. Which finding most influenced your decision?

SEE THE ANSWER & CLINICAL REASONING →

Considering functional medicine training?

The answer page also links to FMU’s professional recognition and educational credential requirements. From there, you can watch a full lesson on lipoprotein(a) with Thomas Dayspring, MD, FACP, FNLA, and explore a five-page written lesson preview on lipid interpretation and clinical reasoning.

Examine both the credentials and the teaching as you consider your training options.

Warmly,
Ron Grisanti, D.C.
Founder, Functional Medicine University

P.S. Have a question about the case? You’ll find a private question-submission link on the answer page. Watch for tomorrow’s challenge—each case stands on its own.