Diagnosis
6
Figure 1. An Approach for the Diagnostic Evaluation of
Adult Men Suspected of Having T Deficiency
History and Physical Examination
Ascertain symptoms and signs of T deficiency
Evaluate for systemic illness, drugs, nutritional deficiency that
could lower T
Measure morning fasting TT
a
(and FT
b
if altered SHBG or borderline TT) (Table 2
c
)
Semen analysis if fertility issue
Consider potentially
reversible functional causes
(Table 1
e
)
Measure prolactin
saturation, iron saturation
Evaluate other pituitary
hormones (if clinically
indicated
f
)
Piuitary MRI (if indicated
g
)
Consider other causes
of symptoms and signs
Confirm by repeating morning fasting
TT (and FT
c
)
Low TT or
Normal or low TT
d
and low FT
Normal TT or
Normal or low TT
d
and normal FT
Diagnosis of hypogonadism is confirmed
LH and FSH low or
inappropriately normal
(Secondary hypogonadism)
LH and FSH high
(Primary hypogonadism)
Measure luteinizing hormone (LH) and
follicle stimulating hormone (FSH)
Obtain karyotype
to diagnose
Klinefelter
syndrome
(if clinical
indication)
