Evaluation for suspected hypogonadism is indicated in men with symptoms and signs of testosterone deficiency – decreased libido, unexplained anemia, and/or osteopenia – and unequivocally and consistently low serum total testosterone and/or free testosterone concentrations, according to the guideline, which is co-sponsored by European Society of Endocrinology and endorsed by the European Academy of Andrology.
The guideline illuminates one area of diagnostic uncertainty that has dogged clinicians: Should one use age-specific testosterone levels? All the guideline authors speaking at the panel, in addition to Dr. Bhasin – Glenn R. Cunningham, MD, Baylor College of Medicine in Houston; Alvin M. Matsumoto, MD, VA Puget Sound Health Care System, Seattle; and Maria A. Yialamas, MD, Brigham and Women’s Hospital, Boston – agreed that age-specific testosterone levels do not improve diagnosis.
“The harmonized Reference range for TT in healthy, nonobese young men (aged 19 to 39 years) was 264 to 916 ng/dL (9.2 to 31.8 nmol/L) using the 2.5th and 97.5th percentile, and 303 to 852 ng/dL (10.5 to 29.5 nmol/L) using the 5th and 95th percentile (31). Clinicians can use this range for all CDC-certified TT assays,” according to the guideline.