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CPE-006 · synthetic case TESTO-FX-19
Confirmed low, gonadotropins missing
The type of hypogonadism cannot be classified yet.
Purpose: The type of hypogonadism cannot be classified yet.
Inputs the engine received
Testosterone and hormones
- Total testosterone, sample 1
- 200 ng/dL
- Total testosterone, sample 2 (separate day)
- 210 ng/dL
Symptoms and findings
- Age
- 49 years
- Low libido
- Yes
What the engine reports
Detected clinical pattern
Criteria for Testosterone Deficiency Met
Symptoms with low total testosterone on two samples (200 and 210 ng/dL). The cause still has to be found.
Why this pattern was identified
- Low testosterone on two samples. 200 and 210 ng/dL are both below 300 ng/dL (AUA). With compatible symptoms, the criteria for testosterone deficiency are met.
Missing information
- LH and FSH (to separate primary from secondary hypogonadism).
- Prolactin.
- SHBG (for calculated free testosterone).
Evidence and rule trace · 2 rules
HG-03Low testosterone confirmed on two samples
Inputs: 200 ng/dL · 210 ng/dL
Biochemically low testosterone on two samples.
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.
- EV-TRAVISON-2017 · Travison TG, Vesper HW, Orwoll E, et al. Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the United States and Europe. J Clin Endocrinol Metab. 2017;102(4):1161-1173.
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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