Diagnosis of Androgen Deficiency in Men

Diagnosis of Androgen Deficiency in Men

Diagnosis of Androgen Deficiency in Men Testosterone, Total Testosterone, Total

«Flowchart»

Clinical Suspicion

Clinical Suspicion

Clinical Suspicion

Total Testosterone (preferably AM)

Total Testosterone (preferably AM)

Total Testosterone (preferably AM)

Confirm by Total T in AM

Confirm by Total T in AM

Confirm by Total T in AM

Measure free T

Measure free T

Measure free T

Androgen deficiency unlikely

Androgen deficiency unlikely

Androgen deficiency unlikely

Androgen deficiency

Androgen deficiency

Androgen deficiency

Low total T or free T

Low total T or free T

Low total T or free T

Measure FSH And LH

Measure FSH And LH

Measure FSH And LH

Primary testicular failure^*

Primary testicular failure^*

Primary testicular failure^*

^*

Secondary hypogonadism^**

Secondary hypogonadism^**

Secondary hypogonadism^**

^**

^* Primary testicular failure: Karyotype to rule out Klinefelter's syndrome

^* Primary testicular failure: Karyotype to rule out Klinefelter's syndrome

^* Primary testicular failure: Karyotype to rule out Klinefelter's syndrome

^*

^** Secondary hypogonadism: Measure prolactin, iron, TIBC, other pituitary hormones, and MRI of pituitary and hypothalamus

^** Secondary hypogonadism: Measure prolactin, iron, TIBC, other pituitary hormones, and MRI of pituitary and hypothalamus

^** Secondary hypogonadism: Measure prolactin, iron, TIBC, other pituitary hormones, and MRI of pituitary and hypothalamus

^**

End

End

End

Total T <250ng/dL (<9nmol/L)

Total T <250ng/dL (<9nmol/L)

Total T <250ng/dL (<9nmol/L)

Total T 250-400ng/dL (90.-13.8 nmol/L)

Total T 250-400ng/dL (90.-13.8 nmol/L)

Total T 250-400ng/dL (90.-13.8 nmol/L)

Total T >400ng/dL >13.8nmol/L)

Total T >400ng/dL >13.8nmol/L)

Total T >400ng/dL >13.8nmol/L)

Low total T and/or free T
Elevated FSH and LH

Low total T and/or free T
Elevated FSH and LH

Low total T and/or free T Elevated FSH and LH

Low total T and/or free T
Low or inappropriately normal FSH and LH

Low total T and/or free T
Low or inappropriately normal FSH and LH

Low total T and/or free T Low