Diagnosis

Diagnosis of male hypogonadism should involve a medical history evaluation, physical examination and laboratory testing.

Outlined below are some important points you should consider when a patient presents with the symptoms of hypogonadism:

Hypogonadism should be diagnosed on the basis of persistent symptoms related to androgen deficiency, and assessment of consistently low testosterone levels (at least on two separate occasions), with a reliable method.1

Diagnostic Evaluation2-7

Although not validated, the ADAM (Androgen Deficiency in the Aging Male) questionnaire can be useful to assist a discussion with the patients about their condition.

Click here to download

Testing blood testosterone and LH levels


Serum testosterone levels should be consistently low, on a minimum of two separate occasions, when diagnosing hypogonadism.6,7


A serum total testosterone assay should indicate both free and bound testosterone. Testosterone deficiency syndrome can be defined in terms of ‘total testosterone’ or ‘free testosterone index, but free testosterone index is more accurate, particularly for older men.7


LH serum levels should also be analysed, to differentiate between primary and secondary forms of hypogonadism.


Hypogonadism may be more subtle and is not always evident by low testosterone levels. For example, men with primary testicular damage often have normal testosterone levels but high LH. This could be considered a subclinical form of hypogonadism, and these men may become hypogonadal in the future.1

Diagnosis and treatment pathway
for hypogonadism.


This flowchart gives more detail on how to diagnose
and treat hypogonadism.


ISA, ISSAM and EAU recommendations adapted from

Nieschlag E, et al. Eur Urol. 2005;48

T thresholds amended according to:

Wang C et al. J Andrology. 2009;30(1)

Testosterone Replacement Treatment (TRT) is the chief treatment option for hypogonadism.
The primary aim is to normalize testosterone levels, in order to provide fast symptom relief 6
and improve the patient’s quality of life.

Find out more about TRT