Hypogonadism is a real condition, but a single low testosterone reading is not a diagnosis. Testosterone peaks in the morning and varies with meals, so both major guidelines require a second fasting morning draw. In the Testosterone Trials screening, only 68.9 percent of men whose first result qualified were still low at the second visit.
Who's who
- Shalender BhasinChair of the Endocrine Society's 2018 testosterone guideline task force
- Thomas TravisonLead author of the 2017 harmonized reference range study
- Peter Snyder+1 more episodeLeader of the Testosterone Trials
- Carl HellerCo-author of the 1944 paper 'The Male Climacteric'
- Gordon MyersCo-author of the 1944 paper 'The Male Climacteric'
Timeline
- 1944Heller and Myers propose male aging as a hormone-deficiency syndrome
- 2016Testosterone Trials main results published in the New England Journal of Medicine
- 2017Harmonized reference range of 264 to 916 ng/dL published
- 2018Endocrine Society and American Urological Association guidelines both require two morning measurements
- 2018Testosterone Trials screening data shows 68.9 percent still low on retest
- 2024AUA lists its 2018 guideline as reviewed and validity-confirmed
Still debated
The two main guidelines differ: the Urological Association names 300 ng/dL as a reasonable cutoff, while the Endocrine Society declines to fix a number. The boundary between functional and organic hypogonadism, especially in obesity, is also contested.