Taken from Andrology Australia

Medical history

  • Undescended testes
  • Surgery of the testes
  • Pubertal development
  • Previous fertility
  • Genito-urinary infection
  • Co-existent medical illness (Pituitary disease, thalassaemia, haemochromatosis)
  • Change in general well-being or sexual function (AD is an uncommon cause of ED. However, all men presenting with ED should be assessed for AD)
  • Degree of virilisation
  • Prescription or recreational drug use

Examination and assessment of clinical features of AD

Pre-pubertal onset – Infancy

  • Micropenis
  • Small testes

Peri-pubertal onset – Adolescence

  • Late/incomplete sexual and somatic maturation
  • Small testes
  • Failure of enlargement of penis and skin of scrotum becoming
  • Thickened/pigmented
  • Failure of growth of the larynx
  • Poor facial, body and pubic hair
  • Gynecomastia
  • Poor muscle development

Post-pubertal onset – Adult

  • Regression of some features of virilisation
  • Mood changes (low mood, irritability)
  • Poor concentration
  • Low energy (lethargy)
  • Hot flushes and sweats
  • Decreased libido
  • Reduced beard or body hair growth
  • Low semen volume
  • Gynecomastia
  • Reduced muscle strength
  • Fracture (osteoporosis)
  • Erectile dysfunction (uncommon)

Laboratory assessment of AD

  • Normal range serum total testosterone 8-27 nmol/L (but may vary according to the assay used)
  • Two morning fasting samples of serum total testosterone*, taken on different mornings
  • Guidelines for the diagnosis of AD (PBS criteria):
    • 1. AD in a patient with an established pituitary or testicular disorder
    • 2. For men aged 40+:
      • Testosterone < 6 nmol/L** OR – Testosterone between 6 and 15 nmol/L and LH greater than 1.5 times the upper limit of the eugonadol reference range for young men**
  • * If a second total testosterone sample is indicated, a LH level should also be ordered. ** These criteria apply to men without underlying pituitary or testicular pathology, to be eligible for PBS subsidy
  • Other investigations
    • SHBG/calculated free testosterone (selected cases – obesity, liver disease)
    • Semen analysis (if fertility is an issue)
    • Karyotype (if suspicion of Klinefelter syndrome, 47,XXY)
  • Investigations if low total testosterone with normal or low LH/FSH:
    • Serum prolactin (prolactinoma)
    • Iron studies (haemochromatosis)
    • MRI (various lesions)
    • Olfactory testing (Kallmann’s syndrome)