Screening For Hypogonadism Research Articles

Screening for hypogonadism: real‐world considerations

Testosterone levels are increasingly being checked in primary care as awareness of the risks of male hypogonadism grows. The authors looked at what tests are performed in general practice in Cheshire to screen for hypogonadism and to rule out secondary hypogonadism.

The Role of Somatic Symptoms in Sexual Medicine: Somatization as Important Contextual Factor in Male Sexual Dysfunction

IntroductionAn important feature of somatic symptom disorder is the subjective perception of the physical symptoms and its maladaptive interpretation. Considering that psychological distress is often expressed through somatic symptoms, it is possible that they underlie at least a part of the symptoms in subjects complaining of sexual dysfunction. Nevertheless, studies on the impact of somatoform disorders in sexual dysfunction are scanty. AimTo define the psychological, relational, and organic correlates of somatic symptoms in a large sample of patients complaining of sexual problems. MethodsA consecutive series of 2833 men (mean age 50.2 ± 13.5 years) was retrospectively studied. Main Outcome MeasuresSomatic symptoms were assessed using the “somatized anxiety symptoms” subscale of the Middlesex Hospital Questionnaire (MHQ-S). Several clinical, biochemical, psychological, and relational parameters were studied. Patients were interviewed with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). ResultsAmong the 2833 patients studied, subjects scoring higher on somatic symptoms were older, more obese, reporting unhealthy lifestyle (current smoking, alcohol consumption), and a lower education (all P < .05). Moreover, they reported a general impairment of their sexuality more often, including erectile problems (spontaneous or sexual-related), low sexual desire, decreased frequency of intercourse, and perceived reduction of ejaculate volume (all P < .005). Interestingly, we observed a significant association between MHQ-S scoring with a reduced testosterone level and hypogonadism symptoms (both P < .05). Finally, we found a significant association between somatic symptoms and both SIEDY Scales 1 (organic domain of ED) and 3 (intrapsychic domain of ED) (both P < .0001). ConclusionThe present study demonstrates that the presence of somatic symptoms can represent an important contextual factor in the determination of or in the exacerbation of male sexual dysfunction. High levels of somatic symptoms in subjects with sexual dysfunction can be related to the sexual symptom itself. The consequences of this pattern have great clinical relevance in a sexual medicine setting, considering their severe impact on sexuality.

HIV-ASSOCIATED MALE HYPOGONADISM

Hypogonadism is found in 15-25% of male HIV patients. This condition is most often hypogonadotrophic by its origin. Less often, its etiology is testicular. Besides impaired sexual functions, such patients experience depression, anemia, and decreased muscular and skeletal mass. When there are no contraindications, testosterone and gonadotropin preparations are used for therapy. The complications of testosterone therapy are manifested as prostate hyperplasia, increased risk of prostate cancer, polycythemia, and sleep apnea. Their risk increase with patients’ age. Screening for hypogonadism is indicated for patients having erectile dysfunctions and depression and includes tests for testosterone and sex steroid-binding globulin.

Present and future association between obesity and hypogonadism in Italian male

Obesity prevalence is increasing worldwide and it is nowadays considered a real public health problem. Obesity is associated with co-morbidities like cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM), furthermore visceral obesity can be related to low testosterone (T) plasma levels. The link between obesity and hypogonadism (HG) is complex and not completely clarified. Current guidelines suggest that screening for HG should be done in subjects with obesity and T2DM. The aim of this evaluation is to assess the estimated actual and future prevalence of obesity and related co-morbidities, in particular HG, in the Italian general population. The Strategyst Consulting Inc. recently completed an epidemiology forecast model for several countries, looking at HG and CV/Metabolic Disease, based on National Health and Nutrition Examination Survey (NHANES) data collected between 1999-2010. Data from NHANES survey were used to evaluate the Italian estimated prevalence of obesity and HG. Results show that obesity estimated prevalence will increase in 2030 also in Italy. In addition, also the prevalence of obese CVD and T2DM subjects will increase too. Even Italian HG prevalence is estimated to increase in the next two decades, irrespective of T threshold considered (< 8, 10 and 12 nmol/L). In obese CVD subjects the relative risk (RR) of developing HG (T < 8 nmol/L) is four times greater than in not-CVD obese subjects (RR = 4.1, 3.1 and 1.9 accordingly to the aforementioned T thresholds for defining HG). Accordingly, the estimated percentage of hypogonadal obese CVD and T2DM subjects will rise in 2030. The Strategyst epidemiology forecast model has allowed to assess the current and future prevalence of obesity and its relative co-morbidities like HG in Italy. Data emerged from this evaluation suggest that obesity and HG prevalence will increase in Italian population and confirm the complex link between adipose tissue and male T levels.

Abrupt decrease in serum testosterone levels after an oral glucose load in men: implications for screening for hypogonadism

This study examines the physiological impact of a glucose load on serum testosterone (T) levels in men with varying glucose tolerance (GT). Cross-sectional study. 74 men (19-74years, mean 51·4± 1·4 years) underwent a standard 75-g oral glucose tolerance test with blood sampling at 0, 30, 60, 90 and 120min. Fasting serum glucose, insulin, total T (and calculated free T), LH, SHBG, leptin and cortisol were measured. 57% of the men had normal GT, 30% had impaired GT and 13% had newly diagnosed type 2 diabetes. Glucose ingestion was associated with a 25% decrease in mean T levels (delta=-4·2±0·3nm, P<0·0001). T levels remained suppressed at 120min compared with baseline (13·7±0·6 vs 16·5±0·7nm, P<0·0001) and did not differ across GT or BMI. Of the 66 men with normal T levels at baseline, 10 (15%) had levels that decreased to the hypogonadal range (<9·7nm) at one or more time points. SHBG, LH and cortisol levels were unchanged. Leptin levels decreased from baseline at all time points (P<0·0001). Glucose ingestion induces a significant reduction in total and free T levels in men, which is similar across the spectrum of glucose tolerance. This decrease in T appears to be because of a direct testicular defect, but the absence of compensatory changes in LH suggests an additional central component. Men found to have low nonfasting T levels should be re-evaluated in the fasting state.

Screening for hypogonadism in diabetes 2008/9: Results from the Cheshire Primary Care cohort

AimThere is increasing awareness of hypogonadism in men with type 2 diabetes but limited data from Primary Care. Subjects and methodsThe anonymised records of 6457 male patients aged 18–80 years with diabetes were accessed. Within the last 2 years 391 men (6.0% of total) underwent measurement of serum testosterone. Data search was performed through the centralised data facility afforded by EMIS®, the majority GP systems provider in Cheshire. Results4.4% of type 2 diabetes men screened were frankly hypogonadal with a serum total testosterone of less than 8.0nmol/l. For borderline hypogonadism (serum total testosterone 8–11.99nmol/l) the proportion of type 2 diabetes men rose to 32.1%. Age adjusted mean (geometric) testosterone was lower in men with type 2 diabetes (13.6nmol/l 95%CI: 13.1–14.2) vs type 1 diabetes (17.9nmol/l; 95%CI 15.2–21.0), F=10.3; p=0.0014. For those screened age adjusted body mass index (BMI) was greater in type 2 diabetes at 30.7 (30.1–31.3) vs 28.4 (26.1–30.6)kg/m2 in type 1 diabetes (F=4.3; p=0.04). Multiple linear regression analysis indicated that there was a statistically significant interaction (P=0.014) between BMI and diabetes type in their relation with log testosterone. For persons with type 1 DM and type 2 DM, testosterone can be expected to decrease by 6% (P=0.002) and by 1% (P=0.002) respectively, for every one unit increment in BMI. ConclusionsThere is manifestly a subset of men with diabetes and androgen deficiency who could benefit from testosterone replacement. BMI has an independent influence on androgen status.

P03-370 - Hysterical traits are not from the uterus but from the testis: A study in men with sexual dysfunction

IntroductionThe relationship between testosterone (T) and psychopathology in subjects with sexual dysfunction has not been completely clarified.Objectives and aimsTo evaluate the association between T levels and different psychopathological symptoms and traits in men seeking treatment for sexual dysfunction.MethodsA consecutive series of 2,042 heterosexual male patients consulting an outpatient clinic for sexual dysfunction was retrospectively studied. Several hormonal, biochemical, and instrumental parameters were investigated, including testis volume and penile blood flow. Patients were interviewed, prior to the beginning of any treatment, with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). They also completed the Middlesex Hospital Questionnaire (MHQ) a brief self-reported questionnaire for the screening of the symptoms of mental disorders in non psychiatric setting.ResultsT levels showed a negative correlation with depressive and anxiety symptoms. Conversely, histrionic/hysterical traits were strongly and positively associated with elevated T. Men with histrionic/hysterical traits had higher androgenization, as suggested by higher total and free T, higher testis volume and a lower ANDROTEST score. They were also characterized by better self-reported sexual functioning and penile blood flow.ConclusionsIn men consulting for sexual dysfunction, histrionic/hysterical traits are associated with higher androgenization and better sexual functioning. Hysteria, previously considered as a typically feminine psychopathological trait, should now be considered as an index of better masculine sexual well-being.

Risk of hypogonadism in male survivors of childhood cancer

New results suggest that male survivors of childhood cancer are at an increased risk of developing low testosterone levels in adult life. Are the data convincing enough to recommend screening for hypogonadism in men treated with chemotherapy and radiotherapy during childhood?

Hypogonadism-related symptoms: development and evaluation of an empirically derived self-rating instrument (HRS ‘Hypogonadism Related Symptom Scale’)

While self-report screening instruments are highly sensitive to hypogonadism in the ageing male, they have lacked specificity as evidenced by low or absent correlations with testosterone. The purpose of this paper was to develop an economical and specific screening instrument for identifying hypogonadal ageing men. Based on a comprehensive study of physical, somatoform and affective complaints, sexual behaviour and function and hormonal parameters of 263 outpatients aged 40 years and above (M = 56.2; 40-84 years) recruited from six andrological outpatient departments in Germany, we identified those items correlating significantly with testosterone. By factor analyses, five factors were identified: 'reduced activity', 'dissatisfaction with sexual function', 'negative self-concept of physical fitness', 'reduced sexual desire' and 'hot flushes'. The corresponding scales were reliable and only moderately inter-correlated. Consistent correlations were found with the level of testosterone, ageing male scales (Androgen Deficiency in the Aging Male, Aging Male Survey), specific affective, somatoform and sexual functioning scales and potential determinants of low testosterone (body mass index, physical inactivity, etc.). While further validation is needed, the new Hypogonadism Related Symptoms Scale appears to be a promising hypogonadism screening tool.

Hysterical Traits Are Not from the Uterus but from the Testis: A Study in Men with Sexual Dysfunction

The relationship between testosterone (T) and psychopathology in subjects with sexual dysfunction has not been completely clarified. To evaluate the association between T levels and different psychopathological symptoms and traits in men seeking treatment for sexual dysfunction. A consecutive series of 2,042 heterosexual male patients (mean age 51.8 +/- 13) consulting an outpatient clinic for sexual dysfunction was retrospectively studied. Several hormonal, biochemical, and instrumental parameters were investigated, including testis volume (Prader orchidometr) and penile blood flow (penile Doppler ultrasound). Patients were interviewed, prior to the beginning of any treatment, with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). They also completed the Middlesex Hospital Questionnaire (MHQ) a brief self-reported questionnaire for the screening of the symptoms of mental disorders in nonpsychiatric setting. T levels showed a negative correlation with depressive and anxiety (somatized and phobic) symptoms. Conversely, histrionic/hysterical traits were strongly and positively associated with elevated T. Men with histrionic/hysterical traits had higher androgenization, as suggested by both higher total and free T, higher testis volume and a lower ANDROTEST score. They were also characterized by better self-reported sexual functioning and penile blood flow. Accordingly, when SIEDY scales were considered, SIEDY scale 2 (relational domain) was significantly lower in subjects with histrionic/hysterical traits further indicating a more satisfying sexual relationship. In men consulting for sexual dysfunction, histrionic/hysterical personality is associated with higher androgenization and better sexual functioning. Hysteria, previously considered as a typically feminine psychopathological trait (the uterine theory), should now be considered as an index of better masculine sexual well-being.

P.1.c.018 Novel neuronal nicotinic receptor selective compounds for the treatment of acute, chronic and neuropathic pain

The relationship between testosterone (T) and psychopathology in subjects with sexual dysfunction has not been completely clarified.To evaluate the association between T levels and different psychopathological symptoms and traits in men seeking treatment for sexual dysfunction.A consecutive series of 2,042 heterosexual male patients (mean age 51.8 ± 13) consulting an outpatient clinic for sexual dysfunction was retrospectively studied.Several hormonal, biochemical, and instrumental parameters were investigated, including testis volume (Prader orchidometr) and penile blood flow (penile Doppler ultrasound). Patients were interviewed, prior to the beginning of any treatment, with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). They also completed the Middlesex Hospital Questionnaire (MHQ) a brief self-reported questionnaire for the screening of the symptoms of mental disorders in nonpsychiatric setting.T levels showed a negative correlation with depressive and anxiety (somatized and phobic) symptoms. Conversely, histrionic/hysterical traits were strongly and positively associated with elevated T. Men with histrionic/hysterical traits had higher androgenization, as suggested by both higher total and free T, higher testis volume and a lower ANDROTEST score. They were also characterized by better self-reported sexual functioning and penile blood flow. Accordingly, when SIEDY scales were considered, SIEDY scale 2 (relational domain) was significantly lower in subjects with histrionic/hysterical traits further indicating a more satisfying sexual relationship.In men consulting for sexual dysfunction, histrionic/hysterical personality is associated with higher androgenization and better sexual functioning. Hysteria, previously considered as a typically feminine psychopathological trait (the uterine theory), should now be considered as an index of better masculine sexual well-being. Bandini E, Corona G, Ricca V, Fisher AD, Lotti F, Sforza A, Faravelli C, Forti G, Mannucci E, and Maggi M. Hysterical traits are not from the uterus but from the testis: A study in men with sexual dysfunction. J Sex Med 2009;6:2321–2331.

The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

The objective of this study was to determine whether hypogonadism and autonomic dysfunction contribute substantially to cancer-related fatigue, decreased sexual desire, and depression in male patients with advanced, incurable cancer. Forty-eight patients who had received no major antineoplastic intervention for at least 2 weeks were tested for autonomic dysfunction by using Ewing tests. Total and free testosterone levels were measured. Multivariate analyses were performed to test the relation of these factors with the Functional Assessment of Cancer Therapy (FACT) (the Functional Assessment of Anorexia/Cachexia Therapy [FAACT] scale and the Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F] subscale), the Hospital Anxiety and Depression Scale (HADS), the Edmonton Symptom Assessment Scale, the Sexual Desire Inventory, and sexual function (Cancer Rehabilitation Evaluation System subscale). Common causes for fatigue (anemia, depression, malnutrition, symptom distress, and medications) also were considered. Thirty-eight of 47 patients (81%) had autonomic dysfunction, although it was not associated significantly with the other variables examined. Twenty-nine of 45 patients (64%) had a low level of free testosterone (hypogonadism), which was correlated with the HADS Anxiety score (P = .002), the FACT Emotional Well-Being score (P = .02), and the HADS Depression score (P = .04). Hypogonadal men also had lower scores on the FACT Functional Well-Being scale (P = .01) and the FACIT-F subscale (P = .05). Men who reported symptoms related to weight loss (FAACT scale) had significantly lower levels of free testosterone (r = 0.34; P = .02) but did not differ from the other group in actual weight loss (P = .22). The total testosterone level was not appropriate for screening of hypogonadism unless the patients had values <100 ng/ mL. Logistic regression analysis failed to reveal a distinct multivariate model of autonomic dysfunction or hypogonadism that predicted clinical outcomes. Hypogonadism is a frequent condition in patients with advanced, incurable cancer and is associated with negative mood, fatigue, and symptoms related to anorexia/cachexia.

Significance of hypogonadism in erectile dysfunction

To review the role and significance of hypogonadism, defined as a low testosterone (T) level, in erectile dysfunction (ED). Review of literature. Serum T is below 3 ng/ml in 12% of ED patients, including 4% before and 15% after the age of 50. Replacement studies in men with severe hypogonadism demonstrate that sexual desire and arousal, as well as the frequency of sexual activity and spontaneous erections are clearly T-dependant. Psychic erections are partly T-dependant. The effects of T upon sexual function are dose-dependant up to a threshold level that is consistent within an individual, but markedly variable between individuals, ranging from 2 to 4.5 ng/ml. More evidence is required to confirm a significant impact of T on the intrapenile vascular mechanisms of erections in men as it is the case in animals. No convincing association of T with ED has been found in epidemiological studies. As concerns clinical experience, although a meta-analysis of the randomized controlled trials established that T therapy consistently restores erectile function in young hypogonadal patients with T below 3.46 ng/ml, the effects of this treatment have been mostly disappointing when used alone in older patients consulting for ED who are subsequently diagnosed to have hypogonadism following routine T measurement. These poor results may probably be explained by the high prevalence of co-morbidities, and by the fact that ED itself may induce hypogonadism. Combination therapy with T and PDE5 inhibitor (PDE5I) may be effective in the hypogonadal ED patients when T therapy alone fails. However, more evidence is required to confirm the hypothesis that a minimum level of T is required for a complete effect of PDE5I in certain men, since a PDE5I was able to restore complete erections in severely hypogonadal men. Though a low T level is not always the only cause of ED in hypogonadal ED patients, there are important benefits in screening for hypogonadism in ED. A low T level justifies a 3 month trial of T therapy, before combining a PDE5I if T therapy alone fails.

The evolving role of testosterone in the treatment of erectile dysfunction

Hypogonadism may play a significant role in the pathophysiology of erectile dysfunction (ED). A threshold level of testosterone may be necessary for normal erectile function. Testosterone replacement therapy is indicated in hypogonadal patients and is beneficial in patients with ED and hypogonadism. Monotherapy with testosterone for ED is of limited effectiveness and may be most promising in young patients with hypogonadism and without vascular risk factors for ED. A number of laboratory and human studies have shown the combination of testosterone and other ED treatments, such as phosphodiesterase type 5 (PDE5) inhibitors, to be beneficial in patients with ED and hypogonadism, who fail PDE5 inhibitor therapy alone. There is increasing evidence that combination therapy is effective in treating the symptoms of ED in patients for whom treatment failed with testosterone or PDE5 inhibitors alone. Testosterone replacement therapy has potentially evolved from a monotherapy for ED in cases of low testosterone, to a combination therapy with PDE5 inhibitors. Screening for hypogonadism may be useful in men with ED who fail prior PDE5 inhibitors, especially in populations at risk for hypogonadism such as type 2 diabetes and the metabolic syndrome.

ORIGINAL RESEARCH—ENDOCRINOLOGY: ANDROTEST©: A Structured Interview for the Screening of Hypogonadism in Patients with Sexual Dysfunction

ABSTRACT Introduction Detecting hypogonadism, which is important in the general population, becomes crucial in patients with sexual dysfunctions, because hypogonadism can have a causal role for them and testosterone (T) substitution represents a milestone for the therapy. Aim No inventories are available for the screening of hypogonadism in patients with sexual dysfunction. We wished to set up a brief structured interview providing scores useful for detecting hypogonadism defined as low total T (&amp;lt;10.4 nmol/L, 300 ng/dL) in a symptomatic population (sexual dysfunction). Methods A minimum set of items was identified within a larger structured interview through iterative receiver-operating characteristic curve analysis, with assessment of sensitivity and specificity for hypogonadism in a sample of 215 patients. Main Outcome Measures Sensitivity and specificity were verified in a further sample of 664 patients. Correlation of test scores with prostate-specific antigen (PSA), testis volume, and others clinical and psychological parameters, was assessed for concurrent validity. Results In the validation sample, the final 12-item version of the interview (ANDROTEST ©) had a sensitivity and specificity of 68% and 65%, in detecting low total T (&amp;lt;10.4 nmol/L) and of 71% and 65%, in the screening for low free T (&amp;lt;37 pmol/L). Furthermore, patients with a pathological test (i.e., score &amp;gt;8) showed higher prevalence of hypogonadism-related signs, such as lower testis volume and higher depressive symptoms. Finally, when only younger patients (&amp;lt;54 years, which represents the median age of the sample) were considered, Log10 [PSA] levels were significantly lower in those with ANDROTEST © score &amp;gt;8. Conclusion ANDROTEST © is a quick and easy-to-administer interview that provides scores for the screening of male hypogonadism in patients with sexual dysfunction.

Does Testosterone Have a Role in Erectile Function?

Purpose Despite the well-established role of testosterone in enhancing libido, its exact contribution to erections in men remains unclear. The main objectives of this review are to clarify the role of testosterone in erectile function and evaluate its therapeutic value in men with erectile dysfunction (ED). Methods Review of the relevant literature (English, French, and Spanish) from 1939 to June 2005 was conducted using data sources from MEDLINE, endocrinology text books, and hand searching of cross-references from original articles and reviews. Clinical trials, animal studies, case reports, reviews, and guidelines of major associations were included. Results Animal and preliminary human studies suggest that testosterone may facilitate erection by acting as vasodilator of the penile arterioles and cavernous sinusoids. Following castration, most, but not all, men had partial or complete loss of erection. Hypogonadism is not a common finding in ED, occurring in about 5% of cases, and in general, there is lack of association between serum testosterone levels, when present in normal or moderately low levels, and erectile function. Most trials using testosterone for treatment of ED in hypogonadal men suffer from methodological problems and report inconsistent results, but overall, suggest that testosterone may be superior to placebo. Erectile function is more likely to improve with testosterone therapy in patients with severe degrees of hypogonadism. Testosterone treatment may ameliorate the response to the phosphodiesterase 5 (PDE5) inhibitors in hypogonadal men and men with low-normal serum testosterone. Repeated measurement of morning serum total testosterone is a fairly accurate and easy method to evaluate androgenecity, but measurement of free or bioavailable testosterone is recommended in conditions that alter the levels of sex-hormone-binding globulin (SHBG), such as in the elderly and in obesity. Conclusions Available data suggest that in most men circulating levels of testosterone, well below the normal range, are essential for normal erection and that higher levels of serum testosterone may not have major impact on erectile function. Screening for hypogonadism in all men with ED is necessary to identify cases of severe hypogonadism and some cases of mild to moderate hypogonadism, who may benefit from testosterone treatment.

Validation of salivary testosterone as a screening test for male hypogonadism

Background. Saliva collection is an easy, non-invasive method to measure hormones.Methods. Two studies were performed. In the first, a convenience sample of 1454 males who had submitted saliva for salivary testosterone measurements were studied. In the second study, we intensively studied symptoms and measurements of total testosterone, free testosterone symptoms and measurements of total testosterone, free testosterone and bioavailable testosterone in relationship to salivary testosterone in 127 men. A secondary endpoint was to examine the relationship of salivary testosterone to hypogonadal symptoms in the ADAM and AMS questionnaires.Results. In the first study, we have shown that salivary testosterone, measured in 1454 males aged 20 to 89 years, declines by 47% over the lifespan. In the second study, salivary testosterone was strongly correlated with bioavailable testosterone (p < 0.000001) calculated free testosterone (p < 0.00001) and total testosterone (p < 0.002). Salivary testosterone was significantly related to hypogonadal symptoms on the St. Louis University ADAM questionnaire and the Aging Male Survey.Conclusions. These studies support the use of salivary testosterone as an acceptable assay for screening for hypogonadism. Salivary testosterone is not a better assay than other measures to diagnose hypogonadism.

Endocrine Screening for Sexual Dysfunction using free Testosterone Determinations

Purpose Controversy exists concerning the need for routine endocrine screening in impotent men. Debate also continues as to what hormonal studies are necessary, the role of the free fraction of testosterone and whether a history of decreased libido or testicular atrophy can predict these endocrinopathies. Materials and Methods We reviewed 508 consecutive men who presented with sexual dysfunction within a 22-month period. Testosterone data were available for 268 patients (53 percent) and prolactin data were available for 170 (33 percent). Results Hypogonadism, defined as 2 abnormal total testosterone levels, was found in 42 of our 268 patients (15.6 percent). A history of decreased libido by patient questionnaire and/or testicular atrophy on physical examination could not predict these cases. A normal free fraction of testosterone saved further unnecessary endocrine evaluation in 50 percent of patients with hypogonadism. Hypoprolactinemia was noted in 3 of 170 patients (1.8 percent). Conclusions Routine endocrine screening remains a necessary part of the evaluation for sexual dysfunction. A history of decreased libido and/or testicular atrophy on physical examination cannot predict hypogonadism. Measurement of free fraction of testosterone will further lessen unnecessary endocrine evaluations by 50 percent and should become standard practice in screening for hypogonadism. Prolactin levels are necessary only in patients with hypogonadism and/or a history of decreased libido.

Endocrine Screening for Sexual Dysfunction using free Testosterone Determinations

Controversy exists concerning the need for routine endocrine screening in impotent men. Debate also continues as to what hormonal studies are necessary, the role of the free fraction of testosterone and whether a history of decreased libido or testicular atrophy can predict these endocrinopathies. We reviewed 508 consecutive men who presented with sexual dysfunction within a 22-month period. Testosterone data were available for 268 patients (53%) and prolactin data were available for 170 (33%). Hypogonadism, defined as 2 abnormal total testosterone levels, was found in 42 of our 268 patients (15.6%). A history of decreased libido by patient questionnaire and/or testicular atrophy on physical examination could not predict these cases. A normal free fraction of testosterone saved further unnecessary endocrine evaluation in 50% of patients with hypogonadism. Hypoprolactinemia was noted in 3 of 170 patients (1.8%). Routine endocrine screening remains a necessary part of the evaluation for sexual dysfunction. A history of decreased libido and/or testicular atrophy on physical examination cannot predict hypogonadism. Measurement of free fraction of testosterone will further lessen unnecessary endocrine evaluations by 50% and should become standard practice in screening for hypogonadism. Prolactin levels are necessary only in patients with hypogonadism and/or a history of decreased libido.