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When is bioavailable testosterone a redundant test in the diagnosis of hypogonadism in men?
Ionela Gheorghiu1, Andriy Moshyk, Raymond Lepage
1Collaborative Research for Effective Diagnostics (CRED), Centre Hospitalier Universitaire de Sherbrooke, 3001 13e Avenue Nord, Sherbrooke, Quebec, Canada J1H 5N4.
Objectives:
Total testosterone (TT) is frequently prescribed with an SHBG and/or free or bioavailable testosterone measurement. Our objective was to identify a TT range for which subsequent SHBG measurement/calculation adds no additional clinical information.
Design And Methods:
Study data were composed of 3955 sets of TT, SHBG and calculated bioavailable testosterone (cBAT) results from unscreened ambulatory male subjects, aged 18-99.
Results:
90% of mismatches between TT and cBAT were observed with TT levels between 6.5 and 13.0 nmol/L, with only slight age variation and no important change with albumin level. SHBG measurement restricted to male patients with TT between 6.5 and 13.0 nmol/L should enable reagent cost savings of over 55%.
Conclusion:
We suggest that a TT level below 6.5 nmol/L or above 13.0 nmol/L provides sufficient useful information for ruling out hypogonadism in ambulatory adult males. This strategy of BAT testing should lead to significant time and cost savings.
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