Testosterone deficiency: workup and monitoring
Also known as:
Male hypogonadism evaluation
A stepwise workup and monitoring schedule aligned with Endocrine Society and AUA guidance.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
Workup
• Symptoms consistent with deficiency
• Two early-morning fasting total testosterone levels; free testosterone if SHBG is abnormal
• LH and FSH to classify primary versus secondary
• Secondary: prolactin, iron studies, other pituitary hormones, and MRI when indicated
• Ask about fertility plans before any treatment
Before starting
• Hematocrit
• PSA and prostate risk discussion where age-appropriate
• Screen for untreated severe sleep apnea
Monitoring
• Testosterone, symptoms and side effects at 3 to 6 months, then yearly
• Hematocrit at 3 to 6 months, then yearly; act above 54%
• PSA per guideline; refer if it rises more than 1.4 ng/mL in 12 months
Cardiovascular safety
TRAVERSE found testosterone noninferior to placebo for major adverse cardiovascular events in men with hypogonadism and elevated cardiovascular risk, with higher rates of atrial fibrillation, acute kidney injury and pulmonary embolism.
Key studies and references
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Section
Diagnosis & monitoring
Also known as
Male hypogonadism evaluation
Reviewed by
Farhan Tahir, MD
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