I typically don't use reference ranges to set off the cutoff. My cutoff typically is 300, sometimes I’ll go to 350. The problem with using the lower limit of the reference range is that there is huge variability from lab to lab. Some studies show almost 325% variability. So again it’s very difficult because some patients you know are hypogonadal are eugonadal in the reference range, and so I don't use the reference range, I use the absolute cutoff.
I think when you look at the diagnosis of hypogonadism, it’s not only the signs and symptoms but it’s also a blood test, and I am more concerned about the signs and symptoms. Some guidelines use 300 nanogram per deciliter as a cutoff, some use 400, some use 350. If I’m ever in concern, I’ll use a free testosterone, because a free testosterone to me is much more accurate.
While the Obesity and Diabetes Guidelines recommend checking a testosterone, the Urologic Association also recommends checking a testosterone in patients who are at high risk, such as those with diabetes and obesity. To me it makes absolute sense to check a testosterone level in these men.
For many years, patients have been concerned about prostate cancer with testosterone. Finally the AUA guidelines have come out stating that there is no evidence suggesting that testosterone causes prostate cancer. Over the past five years, there has been concern with testosterone and cardiovascular disease as well as DVT. Again the guidelines are very clear. There is inclusive evidence to support that testosterone causes cardiovascular risk, and there is no compelling data to suggest that testosterone increases risk for a DVT. So when I counsel my patients, I explain the guidelines and what these findings are.
Prof. Dr. med. Marija Pfeifer Medical Faculty University of Ljubljana, Slovenia
Mohit Khera, M.D., M.B.A., M.P.H. Professor of Urology Scott Department of Urology Baylor College of Medicine Houston, TX
Mohit Khera, M.D., M.B.A., M.P.H.
Professor of Urology, Scott Department of Urology Baylor College of Medicine Houston, TX