Free testosterone management is the clinical strategy focused on maintaining the optimal concentration of unbound, biologically active testosterone in the circulation. Free testosterone, not bound to Sex Hormone Binding Globulin (SHBG) or albumin, is the fraction capable of interacting with androgen receptors to exert its physiological effects. This precise management is crucial for maintaining muscle mass, bone density, and cognitive function.
Origin
The concept arose from the clinical distinction between total and free testosterone measurements, recognizing that total levels can be misleading if SHBG is significantly elevated or suppressed. The necessity for management became apparent in andrology and hormonal health to accurately assess and treat functional androgen deficiency.
Mechanism
Management protocols involve monitoring both total testosterone and SHBG to calculate the free androgen index or direct measurement of the free fraction. Interventions may include adjusting exogenous testosterone dosing, utilizing compounds that modulate SHBG synthesis in the liver, or optimizing metabolic factors like insulin sensitivity that indirectly influence SHBG levels.
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