Algorithm for diagnosing and managing testosterone deficiency (TD) in an adult man

Open Image in Modal

Adapted from Minhas and Mulhall, 2017.1 Copyright © British Society for Sexual Medicine. December 2017.

TT - total testosterone, LH - luteinizing hormone, FSH - follicle stimulating hormone, SHBG - sex-hormonebinding globulin, FT - free testosterone, CV - cardiovascular, CVD - cardiovascular disease, T Therapy -testosterone therapy, HCG -human chorionic gonadotropin, SERMs - selective oestrogen receptor modulators, AIs - aromatase inhibitors, PSA - prostate specific antigen,

*For men with TT levels <5.2nmol/L plus low LH and FSH or increased prolactin levels, refer to endocrinology or arrange a pituitary MRI to exclude a pituitary adenoma (3,6)

**These drugs should not be used if pituitary function is compromised. SERMs and aromatase inhibitors are not currently licensed for TD

References

1. Minhas S & Mulhall J (Eds). Male sexual dysfunction. A clinical guide (2017). John Wiley and Sons Ltd, West Sussex, UK
2. Dohle GH, Arver S, Bettochi C et al. Guidelines on Male Hypogonadism. European Association of Urology 2017. Available at: http://uroweb.org/guideline/male-hypogonadism/ (Accessed May 2018).
3. Khera M, Adaikan G, Buvat J, et al. Diagnosis and Treatment of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2016;13:1787-1804.
4. British Society of Sexual Medicine. Guidelines on the management of sexual problems in men: the role of androgens 2010. Available at: http://bssmorguk.ipage.com/wpcontent/ uploads/2017/05/UK_Guidelines_Androgens_Male_2010.pdf (Accessed May 2018).
5. ISSM (online). ISSM quick reference guide on testosterone deficiency for men. September 2015. Available at: http://www.issm.info/images/uploads/V3.ISSM_-_Guide_for_TD.pdf (Accessed May 2018).
6. Bhasin S et al. Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95:2536-59.
7. Jayasena CN, Anderson RA, Llahana S, et al. Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clin Endocrinol (Oxf). 2022 Feb;96(2):200-19.