Can we get away from serum total testosterone in the diagnosis of andropause?

Because of its multifactorial origin, andropause is usually considered as a clinical entity whose diagnosis is difficult. Practitioners sometimes distrust the symptoms and the diagnostic tools. The clinical manifestations are however the reflection of a lack of anabolism commonly associated with a decreased production of testosterone which is translated in decreased serum values of total testosterone, bioavailable testosterone and calculated values of testosterone. Because of the similarity between the age of the control group and of andropausal men in this study, the Sex Hormone Binding Globulin dogma postulating a modest increase of the glycoprotein with age is evacuated from the argument and therefore it is proposed to rely on total testosterone as a first line assay to support the diagnosis of andropause; however the presence of confounding factors to the diagnosis sometimes require an easy access to calculated values of free or bioavailable testosterone.