Understanding Testosterone & Metabolite Testing: A Clinical Overview
Summary & Reflection on Townsend Letter: Shalima Gordon, ND
Men’s hormone health • Case snapshot: fatigue, reduced libido, weight gain • Beyond serum: why metabolites matter
Hormone balance shapes how men age. In a recent Townsend Letter article, Shalima Gordon, ND, presents a case of a 52-year-old male with fatigue, reduced libido, and weight gain—common signs of changing testosterone dynamics. The piece highlights that symptoms often reflect how hormones are converted and cleared (metabolism), not just how much is present in serum at a single time point.
Key takeaway: Pair serum with urinary metabolites to see the full story—testosterone → DHT/estradiol balance, clearance, and downstream effects that drive energy, body composition, and mood.
Important Interpretation Notes
Markers vs. diagnoses: MVL reports urinary metabolite markers that inform physiology; results must be interpreted by licensed clinicians alongside history, exam, and other labs.
Collection method (24-hour vs. dried urine) reflects integrated metabolism across the window—these are not direct, instantaneous serum hormone values.
Case Snapshot (from the article)
Show Section
- Patient: Male, 52 • symptoms: fatigue, low libido, weight gain.
- Focus: Not only total serum testosterone—also DHT and estradiol formation and clearance.
- Rationale: Metabolic shunts (e.g., 5α-reduction, aromatization) and clearance capacity can drive symptoms despite “normal” serum T.
Why Look Beyond Serum Testosterone?
Show Section
- DHT & estradiol balance: Excess 5α-reduction or aromatase activity can alter body composition, mood, and sexual function.
- Clearance & detox: Phase I/II patterns and conjugation affect symptom persistence.
- Context: SHBG, thyroid, sleep, adiposity, stress/adrenals all modulate androgen availability and signaling.
Testing Strategy (Article Reflection)
Show Section
- Serum: Total testosterone, SHBG (± free T calculation); consider LH/FSH, prolactin as indicated.
- Urine metabolites: Testosterone → DHT pathway, estradiol/estrogen metabolites (e.g., 2/16 balance), conjugation patterns.
- Estradiol & DHT balance: Cross-check serum with urine patterns to see production vs. utilization/clearance.
- Adrenal review when appropriate: Cortisol/cortisone rhythm and metabolites if fatigue or stress dysregulation present.
Clinical Pearls
Show Section
- Individualize: The “right” intervention depends on where the imbalance sits—production, conversion (5α-reduction/aromatase), or clearance.
- Trend with the same method: For monitoring, keep collection type consistent (24-hour or dried) to compare like-to-like.
- Think systems: Sleep, resistance training, nutrition, stress mitigation, and weight management materially impact androgen milieu.
Need Help Interpreting Hormone Test Results?
Show Section
Our clinical team at Meridian Valley Lab supports practitioners with testing kits and interpretation consults to identify what’s truly driving hormonal imbalance—testosterone production, DHT/estradiol balance, or adrenal rhythm.
Practitioners: Contact Client Services for ordering and case consults.
Call: 855.405.8378 | 206.209.4200
Patients: Please speak with your licensed provider. Meridian Valley Lab provides laboratory services only and cannot advise patients directly.
