Male hypogonadism is a clinical condition in which the testes do not produce androgen (testosterone). In order to diagnose hypogonadsim, a male should be experiencing (1) symptoms associated with a deficiency, as well as (2) have a laboratory finding of serum testosterone below accepted levels. [i]
Symptoms and Signs of Hypogonadism: Suggestive symptoms of low T include, but are not limited to:
- Low libido;
- Erectile dysfunction;
- Decreased muscle mass and/or strength;
- Increased body fat;
- Decreased bone density;
- Loss of energy/fatigue;
- Sleep problems;
The problem with associating these symptoms with low T is that many of these symptoms occur in other conditions or are physiologically associated with the aging process itself. Accordingly, these symptoms should be corroborated with a laboratory diagnosis of low T.
Laboratory Diagnosis: According to the Mayo Clinic, a normal reference range of total T levels in adult men over the age of 19 years is 240-950 ng/dl.[iii] Male hypogonadism results from low secretion of T and is generally characterized as concentrations of total T below 240 ng/dl (< 240 ng/dl). However, laboratory testing of T levels can have reliability issues and can vary wildly based upon a subject’s pre-test activities. T levels are subject to variation, which can lead to misclassification. Exercise, diet, illness, certain medications, and even the time of day can all have an influence on T levels. In fact, research has shown that T levels can vary considerably between morning and afternoon as much as an average of 50%[iv],[v]So for example, if a man had his T levels checked in the morning, when they are generally the highest, and had levels of 450 ng/dl, which is well within the normal range, it is entirely possible that his T levels could experience a normal drop to below 225 ng/dl later in the afternoon, falsely indicating he has hypogonadmism. As such, T levels are a relatively crude guideline and should not be used alone in diagnosing and treating hypogonadmism. Rather, in addition to low T levels, men should have clinical symptoms mentioned above.
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[i]American Society for Reproductive Medicine, 2008;90:S83–7, “Androgen deficiency in the aging male.”
[ii]Geriatrics. 2007 Sep; 62(9):15-8, “Review Testosterone replacement in elderly men”
[iv]J Clin Endocrinol Metab. Mar 2009; 94(3): 907–913, “The Effect of Diurnal Variation on Clinical Measurement of Serum Testosterone and Other Sex Hormone Levels in Men”