Assessment and Diagnosis Table 1. Symptoms and signs suggestive of androgen deficiency in men
> Incomplete or delayed sexual development, eunuchoidism > Reduced sexual desire (libido) and activity > Decreased spontaneous erections > Breast discomfort, gynecomastia > Loss of body (axillary and pubic) hair, reduced shaving > Very small or shrinking testes (especially < 5 mL) > Inability to father children, low or zero sperm counts > Height loss, low-trauma fracture, low bone mineral density > Hot flushes, sweats
Table 2. Other symptoms and signs associated with androgen deficiency that are less specific than those in Table 1
> Decreased energy and motivation > Feeling sad or blue, depressed mood, dysthymia > Poor concentration and memory > Sleep disturbance, increased sleepiness > Mild anemia (normochromic, normocytic, in the female range) > Increased body fat, body mass index > Reduced muscle bulk and strength > Diminished physical or work performance
Table 3. Conditions in which there is a high prevalence of low testosterone levels and in which the Endocrine Society suggests measurement of serum testosterone levels
> Sellar mass, radiation to the sellar region, or other diseases of the sellar region > Treatment with medications that affect testosterone production or metabolism, such as glucocorticoids, and opioids
> HIV-associated weight loss > End-stage renal disease and maintenance hemodialysis > Moderate to severe chronic obstructive lung disease > Infertility > Osteoporosis or low trauma fracture, especially in a young man > Type 2 diabetes mellitus and metabolic syndrome
Comment: In men with chronic diseases such as diabetes mellitus, end-stage renal disease, chronic obstructive lung disease, measurement of testosterone may be indicated by symptoms such as sexual dysfunction, unexplained weight loss, weakness, or mobility limitation. In men with some other conditions, such as a pituitary mass, HIV-associated weight loss, low trauma fracture, or treatment with medications that affect testosterone production, measurement of testosterone may be indicated regardless of symptoms.
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