Choosing Wisely:

Don’t prescribe testosterone therapy unless there is laboratory evidence of testosterone deficiency.

Rationale and Comments: With the increased incidence of obesity and diabetes, there may be increasing numbers of older men with lower testosterone levels that do not fully meet diagnostic or symptomatic criteria for hypogonadism. Current clinical guidelines recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs coupled with unequivocally low serum testosterone levels. Serum testosterone should only be ordered in patients exhibiting signs and symptoms of androgen deficiency.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Endocrine Society guidelines
  • Disciplines:
  • Urologic
  • References: • Layton JB, Li D, Meier CR, Sharpless JL, Stürmer T, Jick SS, Brookhart MA. Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. J Clin Endocrinol Metab. 2014;99(3):835-42.
    • Bhasin D, Cunningham GF, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM; Task Force, Endocrine Society. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-59.
    • Liverman CT, Blaze DG, eds. Testosterone and aging: clinical research directions. Washington, DC: The National Academies Press; 2004.

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