Welcome from Glenn R. Cunningham, MD and Diana E. Desai, MD
Diagnosis of testosterone deficiency in men can be challenging due to non-specific symptoms, lack of available screening tools, varying accuracy of testosterone assays, and non-standardized normal ranges. For this issue of EndoScan, we have selected articles that have addressed different factors and tools that are essential in correctly diagnosing testosterone deficiency in men.
Various non-specific symptoms can be found in hypogonadism. Some of the chosen articles help determine which symptoms are correlated with a higher likelihood of androgen deficiency. Much effort has been made to create reliable screening tools, using both qualitative and quantitative measures. Validated tools, such as the HG Screener, are now available to help identify patients more accurately.
Hypogonadism is prevalent in both aging males and type 2 diabetics. We have chosen a few articles that help to characterize hypogonadism in these unique populations. Biochemical and end-organ evidence of late-onset hypogonadism (LOH) have been identified. LOH is found in a minority of elderly males and is usually associated with poor overall health.
Hypogonadism in diabetics is not associated with duration or control of disease. It is instead associated with obesity, low bone mineral density, and mild anemia. Better understanding the features associated with hypogonadism in these populations assists in accurate diagnosis and appropriate therapy.
Because it is essential to confirm the diagnosis with measurement of testosterone levels, articles addressing the issues of accuracy of testosterone assays, standardization of assays and validity of normal ranges and biological variability have been provided.
We think that the past five years has witnessed significant advances in these areas, and the cumulative effect is making it possible to make a diagnosis of androgen deficiency with greater certainty. It will take a few more years before the efforts of The Endocrine Society and the CDC to harmonize testosterone assays with a single standard and to establish more uniform normal ranges are fully realized.