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CPE-006 · Classification
HG-06: Secondary (hypogonadotropic) pattern
Secondary (hypogonadotropic) pattern. Evaluates low total testosterone.
Condition
- low total testosterone
- LH low or inappropriately normal (not above the upper limit)
What it reports
- Pattern of secondary hypogonadism: the problem is above the testes (hypothalamus or pituitary) or functional
Recommended next steps (for physician review)
- Measure prolactin and consider other pituitary hormones
- Review medications, obesity, sleep apnea and chronic illness
Diagnostic boundary
- Functional suppression and pituitary disease look alike here.
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
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-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-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-22
Two low values, no symptoms
A biochemical finding without compatible symptoms.
TESTO-FX-24
Therapy under consideration with untreated sleep apnea
A caution to resolve first.
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