Hypogonadism laboratory findings: Difference between revisions
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{{CMG}} {{AE}} {{AEL}} | {{CMG}} {{AE}} {{AEL}} | ||
==Overview== | ==Overview== | ||
Laboratory diagnosis consistent with cases of hypogonadism | Laboratory diagnosis consistent with cases of hypogonadism is measuring [[testosterone]] levels, [[Gonadotropins|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== | ==Laboratory Findings== | ||
=== Testosterone levels === | === 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). | * 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.<ref name="pmid17090633">{{cite journal| author=Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H| title=Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. | journal=J Clin Endocrinol Metab | year= 2007 | volume= 92 | issue= 2 | pages= 405-13 | pmid=17090633 | doi=10.1210/jc.2006-1864 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17090633 }}</ref><ref name="pmid20525905">{{cite journal| author=Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS et al.| title=Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2010 | volume= 95 | issue= 6 | pages= 2536-59 | pmid=20525905 | doi=10.1210/jc.2009-2354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20525905 }}</ref> | ||
* | * After the diagnosis is confirmed to be hypogonadism, the next step will be the measurement of the [[Gonadotropins|gonadotropin hormones]] [[LH]] and [[FSH]] to detect the cause of the hypogonadism: | ||
** High gonadotropin hormones | ** High [[Gonadotropin|gonadotropin hormones]] level indicates primary hypogonadism and it is called '''hypergonadotropic hypogonadism'''. | ||
** Low gonadotropin hormones level indicates secondary hypogonadism and it is called | ** 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.<ref>{{Cite journal| doi = 10.1001/jama.2015.4179| issn = 0098-7484| volume = 313| issue = 17| pages = 1749–1750| last = Basaria S| title = TEstosterone levels for evaluation of androgen deficiency| journal = JAMA| accessdate = 2015-05-06| date = 2015-05-05| url = http://dx.doi.org/10.1001/jama.2015.4179}}</ref> | * After detecting the site of impairment, further tests need to be performed to determine the exact cause of the disease.<ref>{{Cite journal| doi = 10.1001/jama.2015.4179| issn = 0098-7484| volume = 313| issue = 17| pages = 1749–1750| last = Basaria S| title = TEstosterone levels for evaluation of androgen deficiency| journal = JAMA| accessdate = 2015-05-06| date = 2015-05-05| url = http://dx.doi.org/10.1001/jama.2015.4179}}</ref> | ||
* Free testosterone levels:<ref name="pmid20346001">{{cite journal| author=Ly LP, Sartorius G, Hull L, Leung A, Swerdloff RS, Wang C et al.| title=Accuracy of calculated free testosterone formulae in men. | journal=Clin Endocrinol (Oxf) | year= 2010 | volume= 73 | issue= 3 | pages= 382-8 | pmid=20346001 | doi=10.1111/j.1365-2265.2010.03804.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20346001 }}</ref> | * Free testosterone levels:<ref name="pmid20346001">{{cite journal| author=Ly LP, Sartorius G, Hull L, Leung A, Swerdloff RS, Wang C et al.| title=Accuracy of calculated free testosterone formulae in men. | journal=Clin Endocrinol (Oxf) | year= 2010 | volume= 73 | issue= 3 | pages= 382-8 | pmid=20346001 | doi=10.1111/j.1365-2265.2010.03804.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20346001 }}</ref> | ||
** 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. | ** Measuring free testosterone level is indicated in suspected cases of hypogonadism especially if it is suspected that concentrations of [[Sex hormone binding globulin|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 accurate estimate of the androgen levels. | ** [[Testosterone|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 === | === 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. | * When the [[testosterone]] levels are low, measuring serum levels of [[FSH|Follicular Luteinizing Hormone (FSH)]] and [[Luteinizing hormone|Luteinizing Hormone]] is indicated to know the cause of the disease. | ||
* High levels of FSH and LH (>1-8 mIU/ml) indicates primary cause of hypogonadism. | * High levels of FSH and LH (>1-8 mIU/ml) indicates a primary cause of hypogonadism. | ||
* Low levels of FSH and LH indicates secondary cause of hypogonadism. | * Low levels of FSH and LH indicates a secondary cause of hypogonadism. | ||
=== Semen analysis === | === 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:<ref name="pmid19934213">{{cite journal| author=Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM et al.| title=World Health Organization reference values for human semen characteristics. | journal=Hum Reprod Update | year= 2010 | volume= 16 | issue= 3 | pages= 231-45 | pmid=19934213 | doi=10.1093/humupd/dmp048 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19934213 }}</ref> | * Normal levels of semen:<ref name="pmid19934213">{{cite journal| author=Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM et al.| title=World Health Organization reference values for human semen characteristics. | journal=Hum Reprod Update | year= 2010 | volume= 16 | issue= 3 | pages= 231-45 | pmid=19934213 | doi=10.1093/humupd/dmp048 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19934213 }}</ref> | ||
** 15 million/ml of the ejaculate. | ** 15 million/ml of the ejaculate. | ||
** 39 million/ejaculate. | ** 39 million/ejaculate. | ||
** 40% of the sperms are motile. | ** 40% of the [[Sperm|sperms]] are motile. | ||
* Very low count of semen (<5 million/ejaculate) is mostly associated with primary and secondary hypogonadism. | * Very low count of [[semen]] (<5 million/ejaculate) is mostly associated with primary and secondary hypogonadism. | ||
==References== | ==References== | ||
Latest revision as of 20:10, 3 October 2017
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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.[1][2]
- 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.[3]
- Free testosterone levels:[4]
- 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:[5]
- 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.
References
- ↑ Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H (2007). "Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement". J Clin Endocrinol Metab. 92 (2): 405–13. doi:10.1210/jc.2006-1864. PMID 17090633.
- ↑ Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS; et al. (2010). "Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 95 (6): 2536–59. doi:10.1210/jc.2009-2354. PMID 20525905.
- ↑ Basaria S (2015-05-05). "TEstosterone levels for evaluation of androgen deficiency". JAMA. 313 (17): 1749–1750. doi:10.1001/jama.2015.4179. ISSN 0098-7484. Retrieved 2015-05-06.
- ↑ Ly LP, Sartorius G, Hull L, Leung A, Swerdloff RS, Wang C; et al. (2010). "Accuracy of calculated free testosterone formulae in men". Clin Endocrinol (Oxf). 73 (3): 382–8. doi:10.1111/j.1365-2265.2010.03804.x. PMID 20346001.
- ↑ Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM; et al. (2010). "World Health Organization reference values for human semen characteristics". Hum Reprod Update. 16 (3): 231–45. doi:10.1093/humupd/dmp048. PMID 19934213.