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CPE-006 · synthetic case TESTO-FX-07
Borderline total testosterone
Total testosterone 320 with SHBG 62 and symptoms.
Purpose: Total testosterone 320 with SHBG 62 and symptoms.
Inputs the engine received
Testosterone and hormones
- Total testosterone, sample 1
- 320 ng/dL
- SHBG
- 62 nmol/L
Symptoms and findings
- Age
- 58 years
- Low libido
- Yes
- Fatigue
- Yes
What the engine reports
Detected clinical pattern
Borderline Testosterone With Symptoms
Total testosterone is near the lower limit. SHBG and a free testosterone estimate can help.
Calculations
- Calculated free testosterone (Vermeulen)
- 4.1 ng/dL
No threshold is applied: cutoffs are assay-specific.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Interpret the calculated free testosterone with the total, SHBG and symptoms.
- 2Repeat the morning total testosterone.
Evidence and rule trace · 2 rules
HG-CALC-01Calculated free testosterone
Inputs: total testosterone 320 ng/dL · SHBG 62 nmol/L · albumin 4.3 g/dL
Calculated free testosterone 4.1 ng/dL.
HG-04Borderline total testosterone
Inputs: total testosterone 320 ng/dL · compatible symptoms
Borderline total testosterone.
Evidence
- EV-ES-TRT-2018 · Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
- EV-VERMEULEN-1999 · Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84(10):3666-3672.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and cautions. It does not diagnose, find the cause, or recommend starting, stopping or dosing testosterone therapy. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Against typical adult male reference intervals
Testosterone and hormones
- <264
- 264–299
- 300–350 borderline
- >350
4.3 g/dL is assumed when left empty.
Symptoms and findings
Possible reversible contributors
Testosterone therapy context
More testosterone cases
TESTO-FX-01
Low libido and erectile dysfunction, testosterone never measured
A 48-year-old with sexual symptoms and fatigue.
TESTO-FX-02
One low testosterone
Total testosterone 218 ng/dL on a single morning sample.
TESTO-FX-03
Low on two samples with a primary pattern
Testosterone 205 and 190 with LH 22 and FSH 31.
TESTO-FX-04
Secondary pattern with obesity and diabetes
LH 1.2 and FSH 2.0 with BMI 36.
TESTO-FX-05
Raised prolactin with low testosterone
Prolactin 95 ng/mL.
TESTO-FX-06
Headache, visual field loss and prolactin 310
Possible pituitary mass effect.
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