Hypogonadism laboratory findings: Difference between revisions
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=== 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). It is recommended to be done in the morning as testosterone level is higher in 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> | * 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). It is recommended to be done in the morning as testosterone level is higher in 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> | ||
* If it is confirmed to be hypogonadism, the next step will be measurement of the gonadotropins hormones LH and FSH to detect the cause of the hypogonadism: | * If it is confirmed to be hypogonadism, the next step will be measurement of the gonadotropins hormones LH and FSH to detect the cause of the hypogonadism: | ||
** High gonadotropin hormones leve indicates primary hypogonadism and it is called hypergonadotrophic hypogonadism. | ** High gonadotropin hormones leve indicates primary hypogonadism and it is called hypergonadotrophic hypogonadism. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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). It is recommended to be done in the morning as testosterone level is higher in that time.[1][2]
- If it is confirmed to be hypogonadism, the next step will be measurement of the gonadotropins hormones LH and FSH to detect the cause of the hypogonadism:
- High gonadotropin hormones leve indicates primary hypogonadism and it is called hypergonadotrophic hypogonadism.
- Low gonadotropin hormones level indicates secondary hypogonadism and it is called hypogonadotrophic 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 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 primary cause of hypogonadism.
- Low levels of FSH and LH indicates secondary cause of hypogonadism.
Semen analysis
- Analysis of the male patients semen ,to know th 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.