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Check

Review history, ask questions, and perform a physical to establish a general understanding of the patient’s current health state and assess the underlying etiology.1,3

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Test

Perform a morning total testosterone level test.*3

  • If testosterone levels are normal, no further action is required, and it’s recommended you follow up as needed
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Confirm

Confirm hypogonadism with a second morning total testosterone level test and an LH+FSH test.1,3

  • Use FT or bioavailable testosterone if altered SHBG is suspected3
  • If testosterone levels are normal, no further action is required, and it’s recommended you follow up as needed3
  • Confirm hypogonadism is due to an associated medical condition1,3
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Exclude

If testosterone levels are low, exclude reversible illness, drugs, and nutritional deficiency.3

  • Under certain circumstances while considering differential diagnosis, may need to measure prolactin, iron, other pituitary hormones and conduct MRI3
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Diagnose

Primary hypogonadism: Defined as low testosterone resulting from testicular defect. Low testosterone level, high LH+FSH3

Secondary hypogonadism: Defined as low testosterone resulting from pituitary or hypothalamic defect. Low testosterone level, low or normal LH+FSH3

LH=luteinizing hormone; FSH=follicle-stimulating hormone; FT=free testosterone; SHBG=sex hormone-binding globulin.

*In some laboratories, the lower limit of the normal testosterone range in healthy young men is approximately 280-300 ng/dL (5-9 ng/dL [FT]). Use the lower limit of the range established in your reference laboratory.3