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CPE-006 · synthetic case TESTO-FX-09
Afternoon sample
Testosterone 240 drawn at 3 pm.
Purpose: Testosterone 240 drawn at 3 pm.
Inputs the engine received
Testosterone and hormones
- Total testosterone, sample 1
- 240 ng/dL
- Sample not drawn 7–10 am
- Yes
Symptoms and findings
- Age
- 55 years
- Fatigue
- Yes
What the engine reports
Testosterone varies with time of day and falls in acute illness. Treat this result as provisional and repeat a fasting morning sample.
Detected clinical pattern
Low Testosterone on One Sample — Confirmation Needed
A single low value is not enough. Repeat a fasting morning sample.
Why this pattern was identified
- Low total testosterone, not confirmed. 240 ng/dL is below 300 ng/dL (AUA); second sample not entered. Confirmation on a separate fasting morning sample is required before it is acted on.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Repeat a fasting morning total testosterone before drawing conclusions.
- 2Repeat a fasting morning total testosterone on a separate day.Endocrine Society 2018; AUA 2018.
Missing information
- LH and FSH (to separate primary from secondary hypogonadism).
- Prolactin.
- SHBG (for calculated free testosterone).
Evidence and rule trace · 3 rules
HG-VAL-01Sample timing or illness limits interpretation
Inputs: sample not drawn 7–10 am
Interpretation limited; repeat a fasting morning sample.
HG-02One low testosterone result, not yet confirmed
Inputs: total testosterone 240 ng/dL · second sample not entered
Low total testosterone on a single sample: confirmation is required.
HG-MISS-01Information needed to classify
Inputs: low testosterone · LH missing
Type of hypogonadism cannot be classified without gonadotropins and prolactin.
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-AUA-2018 · Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432.
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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