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CPE-006 · Diagnosis
HG-03: Low testosterone confirmed on two samples
Low testosterone confirmed on two samples. Evaluates two separate total testosterone results, both below 300 ng/dL.
Condition
- two separate total testosterone results, both < 300 ng/dL
What it reports
- Biochemically low testosterone on two samples
- With compatible symptoms, the criteria for testosterone deficiency are met (Endocrine Society 2018, AUA 2018)
Diagnostic boundary
- Establishes the biochemical finding; the cause still has to be found.
Notes
- The Endocrine Society's harmonized lower limit for healthy young men is 264 ng/dL; the AUA uses 300 ng/dL. Values between 264 and 299 are flagged as low under the AUA cutoff only.
Evidence
- EV-ES-TRT-2018Bhasin 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.Supports: Diagnose with symptoms plus unequivocally low testosterone on two morning fasting samples Contraindications and cautions to therapy; monitoring of hematocrit and PSA Evaluation of the type of hypogonadism with LH and FSH
- EV-AUA-2018Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432.Supports: Total testosterone below 300 ng/dL as the threshold; repeat and confirm; fertility counselling before therapy
- EV-TRAVISON-2017Travison 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.Supports: Lower limit of 264 ng/dL in healthy young men
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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-11
Chronic opioid use
Testosterone 210 and 200 with a low-normal LH.
TESTO-FX-12
Fertility desired
Low testosterone in a man trying to conceive.
TESTO-FX-13
Therapy under consideration: hematocrit 52% and PSA 5.2
Cautions to review before any decision.
TESTO-FX-17
Low testosterone with osteoporosis
A fragility fracture and two low values.
TESTO-FX-19
Confirmed low, gonadotropins missing
The type of hypogonadism cannot be classified yet.
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