Let’s say someone doesn’t have sleep apnea, but has an active mind that prevents them from having restful sleep. What would a doctor do if a patient came to them asking to get tested for low testosterone, since low T can cause poor sleep, but also poor sleep can cause low T? Imagine he has tried different ssris to no avail, or the side effects just aren’t worth it to him. Is this the point where most doctors would test for low T? The poor sleep could definitely be caused by depression, which is multi-factorial. So, depression is present, but that could be caused by low T. Let’s say this person tried testosterone on the black market and didn’t get tested beforehand, but his depression lifted and he felt better, less rumination, slept better, etc.? Could this be a sign he had low T to begin with, which caused his depression? Or is it patching up an underlying lifestyle problem that is causing low T? Finally, does it matter?
What would a doctor do if a patient came to them asking to get tested for low testosterone, since low T can cause poor sleep, but also poor sleep can cause low T? Is this the point where most doctors would test for low T?
I can’t generalize and say what “most doctors” would do. If I were in this situation, I would be evaluating for the presence or absence of multiple different signs/symptoms of hypogonadism in order to guide decision making, rather than basing it all on poor sleep in isolation.
Let’s say this person tried testosterone on the black market and didn’t get tested beforehand, but his depression lifted and he felt better, less rumination, slept better, etc.? Could this be a sign he had low T to begin with, which caused his depression?
It is possible, but is absolutely not diagnostic. Response to therapy is not a valid metric for diagnosis, especially for subjective symptoms, given the possibility/likelihood of placebo-like responses, regression to the mean, or other off-target effects.