Hypogonadism laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Laboratory diagnosis consistent with cases of hypogonadism is measuring testosterone levels, gonadotropin hormones level and the semen analysis for the male patients. Testosterone level is low in cases of hypogonadism. Gonadotropin hormones level differs between the primary hypogonadism and secondary hypogonadism. The gonadotropin hormones are high in the primary causes and low in the secondary causes.

Laboratory Findings

Testosterone levels

• Diagnosis of hypogonadism in males is based on two successive low free testosterone level (<0.17-0.31 nmol/L) and total testosterone level (<9.7-10.4 nmol/L). Measurement of testosterone should be done in the morning as testosterone level is higher at that time.
• After the diagnosis is confirmed to be hypogonadism, the next step will be the measurement of the gonadotropin hormones LH and FSH to detect the cause of the hypogonadism:
  • High gonadotropin hormones level indicates primary hypogonadism and it is called hypergonadotropic hypogonadism.
  • Low gonadotropin hormones level indicates secondary hypogonadism and it is called hypogonadotropic hypogonadism.
• After detecting the site of impairment, further tests need to be performed to determine the exact cause of the disease.

• Free testosterone levels:
  • Measuring free testosterone level is indicated in suspected cases of hypogonadism especially if it is suspected that concentrations of sex-hormone-binding globulin are abnormal. It has many calculating methods but the equilibrium dialysis method is known to be better than other methods.
  • Free testosterone and others bound to albumin which is known as bioavailable testosterone also can be measured as it gives an accurate estimate of the androgen levels.

LH and FSH levels

• When the testosterone levels are low, measuring serum levels of Follicular Luteinizing Hormone (FSH) and Luteinizing Hormone is indicated to know the cause of the disease.
• High levels of FSH and LH (>1-8 mIU/ml) indicates a primary cause of hypogonadism.
• Low levels of FSH and LH indicates a secondary cause of hypogonadism.

Semen analysis

• Semen analysis of the male patients, to know the number and the semen motility, is the best way to evaluate the semen production and fertility.
• Normal levels of semen:
  • 15 million/ml of the ejaculate.
  • 39 million/ejaculate.
  • 40% of the sperms are motile.
• Very low count of semen (<5 million/ejaculate) is mostly associated with primary and secondary hypogonadism.