What is the six-item sex hormone test? Why do men also need to do it?

Author: Hu Bintao: Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology

Reviewer: Xu Hao, deputy chief physician of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology

The six-item sex hormone test is a routine test item in endocrine clinics, mainly used for the diagnosis and differentiation of male and female reproductive endocrine dysfunction, sexual dysfunction, infertility, reproductive system tumors and other diseases. However, many men mistakenly believe that the six-item sex hormone test is a test item exclusive to women, and do not understand the meaning of the various indicators in the test results.

So, what are the six sex hormone tests? Which men need to undergo the six sex hormone tests? What are the precautions during the test? Let's find out one by one.

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1. What are the six sex hormones?

Sex hormone test items do not differ depending on the patient's gender, but their meanings are different. For men, six sex hormone tests can be used to determine whether there are reproductive gland dysfunction or endocrine abnormalities. Most of these six indicators are related to male sperm.

1. Luteinizing hormone (LH)

Luteinizing hormone is synthesized and released by the pituitary gland. It acts on the interstitial cells in the testicles, causing them to proliferate, thereby promoting the synthesis of testosterone.

2. Follicle-stimulating hormone (FSH)

Follicle-stimulating hormone and luteinizing hormone are a pair of "brothers", both of which are produced by the pituitary gland. Follicle-stimulating hormone mainly promotes the maturation of seminiferous tubules in the testicles and induces immature sperm cells to mature.

3. Testosterone (T)

Testosterone is the main sex hormone and anabolic hormone in men. It not only promotes the development of sexual organs, but also promotes muscle growth and bone maturity. Most of the testosterone in men is secreted by the testicles, and a small part is secreted by the adrenal glands.

Testosterone produced by the testicles exists in the human body in two forms: free testosterone and bound testosterone. Studies have shown that only free testosterone can bind to androgen receptors, exert physiological effects, and undergo conversion and metabolism. However, conventional sex hormone tests can only detect the level of total testosterone, and cannot accurately detect the level of free testosterone.

4. Estrogen (E2)

Male estrogen comes from two main sources: one is synthesised by the adrenal cortex, and the other is conversion of testosterone by aromatase.

Studies have shown that estrogen promotes the maturation of spermatogenic cells by binding to receptors in the seminiferous tubules and plays an important role in sperm production.

5. Prolactin (PRL)

Prolactin can increase the content of luteinizing hormone, thereby promoting the ability of luteinizing hormone to synthesize testosterone, and ultimately stimulate sperm production. In addition, prolactin can also affect the activity of androgens through androgen receptors, causing changes in gonadal function.

6. Progesterone (P)

Progesterone in men mainly comes from the adrenal glands. It is an intermediate product before the production of androgens and is also an important indicator for judging men's physical health.

2. Which men need to undergo six sex hormone tests?

1. Adolescent boys with delayed sexual organ development

Because testosterone plays an important role in maintaining male secondary sexual characteristics, if testosterone secretion is insufficient, males will not be able to maintain secondary sexual characteristics during puberty development, and in severe cases may even develop feminine characteristics.

Therefore, when adolescent boys show delayed sexual organ development, they should undergo six sex hormone tests as soon as possible, and carry out further examinations and treatments based on the test results.

2. Infertile men

There are many causes of male infertility, such as testicular factors, sperm factors and hypothalamic lesions, all of which may cause men to have normal sexual function but poor semen quality.

Sex hormones are closely related to sperm production, and one or more sex hormone abnormalities may cause male infertility. Therefore, if the wife has not conceived normally after living together for one year and having regular sex without contraception, the husband can consider taking the six sex hormone tests.

3. Men with late-onset hypogonadism

Male late-onset hypogonadism is also known as "male menopause syndrome". Common clinical manifestations include decreased libido, erectile dysfunction, decreased physical strength, osteoporosis, obesity and depression.

If middle-aged or elderly men experience these symptoms, it is best to go to the hospital for six sex hormone tests to diagnose the cause as soon as possible.

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3. What should you pay attention to when doing six sex hormone tests

When the diagnosis of a disease requires six sex hormone tests for identification and confirmation, the patient needs to know the best time for blood collection and other preparations before blood is drawn.

1. It is best to complete blood collection before 11:00 noon

This is because male androgen secretion has a clear circadian rhythm, which is higher in the morning and lower at night. The peak serum testosterone levels of normal young and middle-aged men are between 6:00 and 11:00 (24-hour system).

The rhythmicity of total serum testosterone levels in elderly men will become sluggish. Therefore, for elderly men, if only total serum testosterone levels are measured, the blood collection time can be relaxed. Patients who are admitted in the afternoon do not need to have blood drawn again in the early morning.

2. Regular work and rest is important

Irregular work and rest schedules for men will significantly affect the circadian rhythm of serum testosterone, so men should ensure a regular work and rest schedule and adequate sleep before blood collection, so that the test results are more reliable.

3. Multiple testing is necessary

Because there may be large differences in androgen levels in a stable state over a short period of time, it is necessary for men to repeatedly measure androgen levels. It is usually recommended to have an interval of 1 week or 2 to 4 weeks.

References

【1】Wu Jianfeng. Study on the correlation between male basal hormone levels and sperm quality parameters[J]. Journal of Modern Laboratory Medicine, 2020, 35(03): 69-71, 77.