Identify hypogonadism with our testing strategy
Our adult male hypogonadism diagnostic algorithm provides a testing strategy for the diagnosis and classification of hypogonadism in men.
Get the insights you need to diagnose and manage male reproductive disorders
Prevalence of hypogonadism
Male hypogonadism is a clinical syndrome resulting from decreased testosterone and/or sperm production.1 It is estimated that 35% of men over 45 years of age have hypogonadism.2 There is a higher prevalence of hypogonadism in older men, obese men, and men with type 2 diabetes.2
Types and causes of hypogonadism
Hypogonadism can occur in 3 forms: primary, secondary, and combined. If initial and confirmatory testing indicates low testosterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH) should be measured to distinguish between primary and secondary hypogonadism.1
When hypogonadism is diagnosed in men, additional diagnostic evaluation is recommended to determine the cause(s), which are classified as either organic or functional.
Organic causes include congenital, structural, or destructive disorders that suppress the hypothalamus, pituitary, or testis. Functional causes include conditions that suppress gonadotropins and testosterone concentrations, including diabetes, obesity, and the use of opioids.1
Diagnosing and managing hypogonadism
Laboratory testing is recommended for the diagnosis of men with suspected hypogonadism, especially when conditions associated with a high prevalence of low testosterone are present.1,3
Individuals suitable for testing
- Men with symptoms, signs, or conditions associated with hypogonadism1,3
- Men who are receiving testosterone replacement therapy (TRT)1,3
| Specific |
Suggestive | Nonspecific |
| Incomplete or delayed sexual developmenta Loss of body hair Very small testes (<6 mL) |
Reduced libidoa Decreased spontaneous erections |
Decreased energy, motivation, initiative, self-confidence Increased body fat, BMI |
BMI, body mass index.
aHigh-prevalence conditions of low testosterone for which serum testosterone measurements are suggested.1
bEunuchoid body appearance is typical of hypogonadism occurring before epiphyseal fusion.
aHigh-prevalence conditions of low testosterone for which serum testosterone measurements are suggested.1
bEunuchoid body appearance is typical of hypogonadism occurring before epiphyseal fusion.
| Conditions associated with decreased SHBG1 |
| Insulin resistance |
| Obesity |
| Diabetes mellitus |
| Use of glucorticoids, some progestins, and androgenic steroids |
| Nephrotic syndrome |
| Hypothyroidsim |
| Acromegaly |
| Polymorphisms in the SHBG gene |
| Conditions associated with increased SHBG1 |
| Aging |
| HIV disease |
| Cirrhosis and hepatitis |
| Hyperthyroidism |
| Use of some anticonvulsants |
| Use of estrogens |
| Polymorphisms in the SHBG gene |
Guideline-supported testing recommendations
Initial diagnostic testing for low testosterone involves measuring morning fasting total testosterone (TT)1 by Liquid Chromatography, tandem mass spectrometry (LC-MS/MS), which is advantageous because:
- LC-MS/MS provides a more precise and accurate measurement of TT at lower concentrations than immunoassay
- LC-MS/MS is the recommended assay in the Endocrine Society guidelines1
Quest Diagnostics offers a Total Testosterone LC-MS/MS assay that is certified by the CDC Laboratory/Manufacturer Hormone Standardization (HoSt) Program, which is the Endocrine Society–recommended assay for healthy men older than age 18.1,4
Measurement of free testosterone (FT) is guideline-indicated if TT is reported near the lower limit of normal or if alterations in SHBG that affect TT are suspected.1 Guidelines recommend measuring FT by LC-MS/MS and an equilibrium dialysis method.1 The Endocrine Society recommends to confirm a low testosterone value with a second 8 AM measurement, and to initiate early treatment if both values are below normal.
Monitoring patients with hypogonadism during testosterone therapy
The Endocrine Society recommends:
- Testosterone therapy in hypogonadal men to induce and maintain secondary sex characteristics and correct symptoms of testosterone deficiency1
- Monitoring testosterone, hematocrit, prostate-specific antigen (PSA), and measurement of bone mineral density (BMD) for men who have started testosterone therapy1
Quest Diagnostics offers several tests to help you monitor patients undergoing testosterone therapy, including:
Get the answers you need to support care pathways for patients with hypogonadism
Explore the common symptoms of hypogonadism, guideline-recommended testing options to help inform a diagnosis, and recommended testing options for patients on testosterone therapy.
References
- 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. doi:10.1210/jc.2018-0022e
- Endocrine Society. Hypogonadism in men. January 24, 2022. Accessed February 8, 2024. https://www.endocrine.org/patient-engagement/endocrinelibrary/hypogonadism
- Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-2559. doi:10.1210/jc.2009-235a
- Centers for Disease Control and Prevention. HoSt/VDSCP certified participants. Testosterone in serum; 2023. Accessed April 4, 2024. https://www.cdc.gov/labstandards/csp/pdf/hs/CDC_Certified_Testosterone_Assays-508.pdf
Questions?
Connect with our experts to help you manage the care pathway for patients with testerone deficiency.
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