How is Low Testosterone (Hypogonadism) diagnosed?

What is hypogonadism?

Hypogonadism, also known as low testosterone, is a common condition in men.¹ Symptoms typically occur as a result of low levels of testosterone, a key hormone involved in maintaining overall health and wellbeing.¹ There are thought to be a number of men with hypogonadism that are yet to see their doctor and receive a diagnosis.²

Learn more about Hypogonadism

Why is getting a diagnosis important?

Hypogonadism can have a significant impact on overall health and wellbeing. It’s a treatable condition with medication and can be managed well, so getting a diagnosis is important. Early diagnosis and treatment may help protect against the development of osteoporosis, loss of muscle mass and the development of other associated conditions, while also alleviating other symptoms.³

Learn more about the treatment options for Hypogonadism‍

‍The process of obtaining a clinical diagnosis

Diagnosis of hypogonadism is based on:⁴

1. The assessment of signs and symptoms  
2. Confirmation of testosterone deficiency via a blood test  

The assessment of symptoms may also be aided by use of tailored questionnaires such as the Androgen Deficiency Aging Males (ADAM) questionnaire which is designed to identify men who are exhibiting signs of hypogonadism.³  

‍1. Signs and symptoms of Hypogonadism

Hypogonadism can present with a range of symptoms, all or some of which you may be experiencing as a patient. Your managing doctor will conduct a physical examination and ask questions to get a complete picture of your condition, assessing whether any symptoms or features of hypogonadism are present.⁴

Questions could include whether any changes in sexual function such as erectile dysfunction or loss of interest in sex (low libido) are occurring. Other questions around mood, such as feeling down, depressed or irritable, as well as any difficulty concentrating on different tasks, may also be explored.³ You may also assess if you have reduced body hair and whether you have lost any muscle mass or strength.⁴

2.  Testosterone blood test

If it appears you do have symptoms of hypogonadism the next step is to carry out a blood test to measure testosterone levels in the blood. It’s recommended that testosterone levels are measured in the morning after an overnight fast, when testosterone levels are highest, between the hours of 8 am and 11 am.^1,3,4

Particularly in younger patients, levels of other hormones are also measured in the same blood test which allows doctors to identify what the cause of hypogonadism might be.⁴

In older patients, if the test results indicate that testosterone levels are low to normal, the blood test may be repeated to ensure the correct diagnosis is made.⁴ Once low testosterone levels are confirmed, further testing is carried out to identify if the cause is testicular, hypothalamic, or pituitary. The most common tests include measuring hormone levels, semen analysis, and in rarer cases, testicular biopsies and genetic predisposition.²

If you are diagnosed with hypogonadism, the good news is that it's a treatable condition. Once the treatment starts, you may continue to have testosterone levels assessed to determine if the medication is raising testosterone levels to the appropriate level.³

‍Screening

‍While screening for men who may be hypogonadal is not routine, there are some key characteristics which should be recognised as flags for potential hypogonadism.  

These include the presentation of the following signs and symptoms:¹  

• Erectile dysfunction, low sexual desire and loss of spontaneous erections
• Men with type 2 diabetes, a BMI >30 kg/m² or waist circumference >102 cm
• Men on long-term opiate, antipsychotic or anti-convulsant medication  
  

What are the benefits of treatment?

Treating hypogonadism has a multitude of benefits. The standard treatment is testosterone replacement therapy and The British Society for Sexual Medicine recognises the benefits of testosterone replacement therapy, including:¹

• Improved sexual function such as reduced erectile dysfunction, desire and satisfaction
• Reduced BMI and waist size
• Improved lipid profile, glycaemic control, body composition, bone mineralisation and features of metabolic syndrome
  

The benefits of testosterone treatment are typically observed after six months of treatment. For some patients, treatment is intentionally short term, but for many, long-term adherence is required to improve symptoms of hypogonadism.¹

If you are concerned about your health, or suspect you may have hypogonadism, it’s important to visit your healthcare professional to receive a correct diagnosis, and if appropriate, treatment to resolve your symptoms.  

Learn more about hypogonadism treatment

Take home points:

• Hypogonadism is a common condition in men characterised by low levels of testosterone in the blood
• Diagnosis includes a quick questionnaire and physical examination, often followed by blood tests to confirm clinically low levels of testosterone

• Hypogonadism is a treatable condition, and if you suspect you have hypogonadism, make sure to visit your healthcare professional to receive a correct diagnosis

‍TRTed Toolkit

• You can find the hypogonadism diagnosis guidelines on the TRTed Toolkit here

Join the conversation on the TRTed Community!

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References  

1. Hackett G, et al. J Sex Med. 2017;14(12):1504-1523.
2. Muneer A. Trends in Ur, G & Sex Health. 15 (2). 14-17.
3. Carnegie C. Rev Urol. 2004; 6(Suppl 6): S3–S8.
4. Kumar P, et al. J Adv Pharm Technol Res. 2010 Jul-Sep; 1(3): 297–301.