15th April 2024

Diagnosis

The diagnosis of hypogonadism is based on the presence of characteristic signs/symptoms along with reduced blood serum concentration of total testosterone or free testosterone.

Signs and symptoms

According to the 4th international consultation for sexual medicine (ICSM), hypogonadism should be diagnosed based on particular signs and symptoms:

• Sexual dysfunction: This includes reduced sexual desire, decreased morning/nocturnal erections and erectile dysfunction.
• Reduced physical vigour, reduced energy levels, reduced motivation, fatigue, depressed mood and disturbances in sleep
• Hot flushes, changes in cognition and memory
• Visceral obesity with reduced muscle mass/bone density
• Small testis, gynecomastia, reduced body hair

Laboratory diagnosis

Testosterone levels should be investigated in all patients presenting with erectile dysfunction.

Serum levels of testosterone have a diurnal rhythm with testosterone levels highest in the early morning, testosterone levels are recommended to be measured before 11am (7am – 11am) at least twice, 4 weeks apart and preferably not during an acute illness. This includes either total testosterone (TT) or free testosterone (FT).

If FSH and LH levels are low, prolactin levels should also be investigated to differentiate between primary and secondary hypogonadism.