And having balanced T levels is necessary for optimal health and growth, regardless of sex. Blood tests - measurement of morning basal testosterone, LH, FSH, PRL - measurement of the basal levels of testosterone, LH and FSH will allow distinction between gonadal disease and hypothalamic-pituitary disease (1,2,3) The benefits of testosterone replacement therapy may include restoring metabolic parameters to the eugonadal state; improving psychosexual function and intellectual capacity, including depression and lethargy; maintaining bone mineral density and reducing bone fractures; improving muscle mass and strength; and enhancing quality of life. Monitoring of the prostate (assessed with DRE and PSA assay) and hematocrit and lipid profile should be repeated during testosterone replacement therapy. To diagnose a patient as hypogonadal, the Endocrine Society recommends measuring serum testosterone twice. Table 1 shows the percentage of men receiving recommended screening tests before and after initiating testosterone therapy. To ensure that the laboratory database included all laboratory values for a given patient, we required that the laboratory value have a match with the CPT claims data based on date. We also examined two subcohorts of patients who had complete data for laboratory values. We assessed laboratory values only in men with complete information in the laboratory data file during the study period. This retrospective cohort study used administrative health data from Clinformatics DataMart (CDM). However, patients receiving injections of testosterone enanthate or cypionate every 2 weeks will require an earlier measurement of serum testosterone at 1 to 2 weeks after commencement of therapy.3 In cases of primary and permanent secondary hypogonadism diagnosed in the prepubertal male, life long testosterone treatment is needed. If the total testosterone level is normal in the aging male presenting signs of hypogonadism, the clinician can measure free testosterone or measure SHBG and calculate bioavailable testosterone.9 To differentiate primary from secondary hypogonadism, early morning luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels must be obtained. Transient secondary hypogonadism might be related to malnutrition or stress states and can be diagnosed by physical examination and evaluation of the patient’s growth chart. A karyotype should be obtained to diagnose chromosomal abnormalities, such as Klinefelter’s syndrome, and a physical examination will reveal small or absent testes resulting from anorchia, Noonan’s syndrome, or other testicular disorders. A raised prolactin level suggests that further investigation of the pituitary gland should be undertaken.1,2 Because total testosterone and SHBG assays are readily available and cheap, calculating bioavailable testosterone might be a good compromise. In contrast, the radioimmunoassay for free testosterone is widely available but unreliable. Free testosterone can be measured by equilibrium dialysis or ultrafiltration, which are difficult to perform and largely unavailable but reliable. This investigation of one of the nation's largest commercially insured populations is the first large-scale study of serum testosterone and PSA testing both before and following the initiation of testosterone therapy. In the 12 months following initiation of testosterone therapy, 52.4% of patients received a serum testosterone test and 43.3% received a serum PSA test (Table 1). The study team examined serum testosterone and PSA laboratory results using the CDM laboratory database. In the 12 months before initiating treatment, 73.4% of male testosterone users received a serum testosterone test and 60.7% received a prostate-specific antigen (PSA) test.
