Male hypogonadism is a clinical diagnosis confirmed by consistent biochemical findings. Clinical guidelines agree that the initial diagnostic test to confirm clinically suspected androgen deficiency should be a fasting morning total testosterone concentration by a reliable assay. They also agree that a diagnosis of androgen deficiency should only be made in men with consistent symptoms and signs, and unequivocally and repeatedly low serum testosterone concentrations.However, what should be done when the total testosterone is near the lower limit of the reference range, but not clearly low? Most guidelines suggest that obtaining a free testosterone concentration either by equilibrium dialysis or by calculation with a validated algorithm should be the next step. Because serum sex hormone binding globulin (SHBG) concentrations affect total testosterone concentrations and their interpretation (Figure ), a free testosterone measurement is also recommended if a condition associated with alterations in circulating SHBG is suspected. In practice, however, equilibrium dialysis is usually not available, and some formulae used to calculate free testosterone have not been fully validated. Moreover, while recent progress has been made towards standardization of reference intervals for total testosterone, normal ranges for free testosterone remain currently less well defined.Changes in SHBG are associated with parallel changes
Clinical Endocrinology – Wiley
Published: Jan 1, 2018
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