Hormones

Hormone questions after 40 tend to arrive as a single number: a TSH above range, a testosterone below 300, a weight that started moving at the menopause transition. This pillar holds the guides that put each number back into the context its guideline gives it, so that a lab result becomes a decision rather than a verdict. The TSH and total testosterone reference ledgers carry the ranges with their sources.

Subclinical hypothyroidism is a TSH above the reference range with a free T4 inside it, and it is defined by lab results, not symptoms. The AACE and ATA guideline says the decision to treat when TSH is below 10 mIU/L should be tailored to the individual patient, and the largest trial of treating it in older adults, TRUST, randomized 737 people aged 65 and over and found levothyroxine lowered TSH while improving neither symptoms nor tiredness at one year. The US Preventive Services Task Force gives screening for thyroid dysfunction in asymptomatic non-pregnant adults an I statement. High TSH with a normal free T4 and TSH normal range cover the guideline, the trial, and why the upper limit widens with age.

The AUA uses a total testosterone below 300 ng/dL as a reasonable cutoff supporting a diagnosis of low testosterone, and the diagnosis requires two early-morning measurements on separate occasions plus symptoms or signs. One afternoon result is not a diagnosis. Testosterone falls with age, weight gain, poor sleep and illness, so the number alone does not say why it is low, and testosterone therapy suppresses sperm production, which men who want future fertility need to raise before starting. Low testosterone follows the guideline statement by statement.

In the SWAN cohort, whose published slopes are for the White referent group and differ by race and ethnicity, the slope of body weight and BMI at the onset of the menopause transition did not differ from the premenopausal slope. What changed was composition: fat gain roughly doubled, from about 1.0 to 1.7 percent a year, while lean mass switched from gaining to losing, and visceral fat began rising at 6.24 percent a year even as waist girth grew at a rate not statistically different from before. The change also ends: fat and lean mass trajectories decelerated to zero slope after the transition, and NAMS describes weight changes flattening about two years after the final period. Menopause weight gain reports the cohort figures and what they mean for what to measure.

Bring the actual number and the time of day it was drawn. For TSH, the guides tell you which zone it falls in and whether the guideline calls that zone a treatment decision or an individualized one. For testosterone, they tell you whether the result meets the AUA's two-draw rule before anyone discusses therapy. For the menopause transition, they tell you which measurement tracks the change that is happening. Telehealth prescribing of testosterone has its own rules, covered under telehealth.