When to Check Testosterone in Middle-Aged Males
The Core Rule: Symptoms First, Always
Do not check testosterone in asymptomatic males — regardless of comorbidities or risk factors. Population screening is not recommended.
Test when clinical symptoms or signs of hypogonadism are present:
- Decreased libido
- Reduced morning erections
- Loss of body hair
- Low bone mineral density / osteoporosis or low-trauma fracture
- Gynecomastia
- Small testes
- Infertility
High-Risk Conditions → Raise Your Index of Suspicion
The following conditions are associated with higher prevalence of hypogonadism. They do not justify testing on their own, but if a patient with one of these conditions also has symptoms, your threshold to test should be lower:
| Condition |
|---|
| Diseases of the sellar region (pituitary/hypothalamic) |
| Prolonged high-dose glucocorticoid use |
| Sustained-release opioid use |
| HIV-associated weight loss |
| End-stage kidney disease |
| Moderate-to-severe COPD |
| Infertility |
| Osteoporosis or low-trauma fracture |
| Type 2 diabetes mellitus |
Example: A man with T2DM has higher prevalence of low testosterone, but do not check a level unless he also reports low libido, ED, or other symptoms.
Source: UpToDate — Clinical features and diagnosis of male hypogonadism
Related notes: