Diagnostic Tools

Diagnosis of hypogonadism is based on comparison with age- and sex-adjusted normative ranges for serum androgen concentrations.1 

For a full overview of the suggested routes to diagnosis of androgen deficiency in HIV-infected males, download the schematic outline.  



Clinical evaluation, using questionnaires developed as screening tools for hypogonadism, is useful in identifying the clinical features of hypogonadism.

Questionnaires that are available for male patients with hypogonadism and may be useful in facilitating discussion of symptoms include:

Although ADAM and AMS are useful screening tools, both are relatively non-specific.2 
If an abnormality is suspected, evaluation of total testosterone should be performed; however, if clinical findings indicate that hypogonadism is present but total testosterone is normal or borderline low, serum hormone-binding globulin (SHBG) bound testosterone and free testosterone should be measured as well.3


Although the morning measurement of total testosterone and free testosterone (by radioimmunoassay [RIA]) has been recommended4, there is debate as to the usefulness of such assays in the differential diagnosis of hypogonadism in HIV-infected males, as a study by Moreno-Pérez et al. has associated the diagnostic method with sensitivity of less than 30% for detecting hypogonadism.5 



Assessment of androgen levels in women is not recommended in the Endocrine Society Guidelines due to the lack of a well-defined clinical syndrome and normative data on total or free testosterone levels that can be used to define the disorder.6

References

  1. Mylonakis E, Koutkia P, Grinspoon S. Diagnosis and treatment of androgen deficiency in human immunodeficiency virus-infected men and women. Clin Infect Dis. 2001;33:857–864.
  2. Morley JE, Perry HM 3rd, Kevorkian RT, et al. Comparison of screening questionnaires for the diagnosis of hypogonadism. Maturitas. 2006;53:424–429.
  3. American Association of Clinical Endocrinologists. Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hypogonadism in Adult Male Patients - 2002 update. Accessed 2 July 2012.
  4. Endocrine Society. Clinical Guidelines on Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes. 2010. Accessed 22 February 2011.
  5. Moreno-Pérez O, Escoín C, Serna-Candel C, et al. The Determination of Total Testosterone and Free Testosterone (RIA) are not Applicable to the Evaluation of Gonadal Function in HIV-Infected Males. J Sex Med. 2010;7:2873–2883.
  6. Endocrine Society. Androgen Therapy in Women. 2006. Accessed 2 September 2011.