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CPE-006 · synthetic case TESTO-FX-15
On therapy, monitoring overdue
Hematocrit last checked 18 months ago, no PSA on record.
Purpose: Hematocrit last checked 18 months ago, no PSA on record.
Inputs the engine received
Symptoms and findings
- Age
- 52 years
Testosterone therapy context
- Currently on testosterone therapy
- Yes
- Hematocrit
- 48 %
- Months since last hematocrit
- 18 months
What the engine reports
Detected clinical pattern
On Testosterone Therapy — Monitoring Pathway
Measured testosterone and gonadotropins reflect the exogenous exposure, so baseline hypogonadism is not classified. Monitoring prompts apply.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Hematocrit has not been checked in the last 12 months (guidelines check it at baseline, 3–6 months and then yearly).
- 2PSA has not been checked in the last 12 months (men aged 40 and over on therapy).
Differentials, pitfalls and contradicting signals
- Exogenous androgens suppress LH and FSH and change testosterone; baseline status cannot be read from these values.
Evidence and rule trace · 2 rules
HG-EXO-01Exogenous androgen or testosterone therapy
Inputs: on testosterone therapy
Baseline hypogonadism cannot be classified while exogenous androgens are being taken.
HG-12Testosterone-therapy monitoring
Inputs: hematocrit 48% · hematocrit 18 months ago · PSA not checked
Monitoring prompt for testosterone therapy.
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.
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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