GPAtlas🧭 When to suspect
Testosterone deficiency (the term the British Society for Sexual Medicine now prefers to “hypogonadism”) is a clinical and biochemical diagnosis.
• It requires consistent symptoms together with two low early-morning testosterone levels.
• A number on its own is never the diagnosis.
• Asymptomatic men without an associated condition should not be screened.
The three commonest symptoms are:
• Erectile dysfunction
• Reduced libido
• Loss of early-morning erections – worth asking about even in a man who is not currently sexually active, as their absence is a useful pointer
Beyond sexual symptoms, deficiency often hides behind fatigue, low mood and a cluster of metabolic problems, so a low testosterone is frequently functional (driven by obesity, type 2 diabetes or chronic illness) rather than true gonadal failure.
In practice:
• Test the right men in the right way
• Separate primary from secondary deficiency
• Exclude prostate cancer and protect fertility before any thought of treatment
| Symptoms that should prompt a test |
|---|
|
• Erectile dysfunction, low libido, loss of morning erections (the classic triad) |
|
• Fatigue, reduced vigour, low mood, irritability, poor concentration |
|
• Gynaecomastia, hot flushes or sweats |
|
• Reduced muscle mass/strength; increased central fat; reduced shaving frequency |
|
• Headache or visual disturbance (think pituitary – see Red Flags) |
| Conditions & medications that should prompt a test |
|---|
|
• Type 2 diabetes, obesity or metabolic syndrome (a low result is often functional/non-gonadal) |
|
• Osteoporosis or a low-trauma fracture; unexplained anaemia |
|
• Pituitary or hypothalamic disease; HIV with weight loss; chronic kidney disease, COPD |
|
• Long-term opioids, oral glucocorticoids, antipsychotics; anabolic-steroid use (past or present) |
|
• Undescended testes, mumps orchitis, testicular trauma/surgery, prior chemo- or radiotherapy; Klinefelter’s |
Source: BSSM 2023 · Society for Endocrinology
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