Testosterone deficiency in men (hypogonadism: suspicion and monitoring on testosterone)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspected deficiency
First measurement, in the morning between 7 am and 10 am, fasting
- Total testosterone
- SHBG (if obesity, diabetes, advanced age, thyroid dysfunction, liver disease, etc.)if needednon-French guidelineSituation that alters SHBG: allows free testosterone to be calculated [1].
If total testosterone < 12 nmol/L: repeat on another day, in the morning, fasting
- Total testosterone (repeat)
- LH
- FSH
- Serum prolactin (reduced desire or low or normal LH)if needednon-French guidelineReduced libido or secondary hypogonadism [1].
- Transferrin saturation (low or normal LH)if needednon-French guidelineSecondary hypogonadism: look for haemochromatosis [1,2].
- Karyotype (high LH and FSH, small testes)if needednon-French guidelinePrimary hypogonadism: look for Klinefelter syndrome [1,2].
Do not order
- Testosterone measurement in a man without symptoms, or screening by questionnaire: not recommended [1].
- Testosterone sampled in the afternoon or after a meal: underestimated (by more than 30% after a meal) [1].
- Free testosterone by direct immunoassay: unreliable, to be avoided; calculate it from total testosterone, SHBG and albumin [1].
- Testosterone treatment of a man without confirmed deficiency: no demonstrated benefit on sexual function above 12 nmol/L [1].
- Measurement during acute illness or its convalescence, or on a short treatment that lowers testosterone (opioids): do not do [2].
Before and on testosterone treatment
Before treatment
- FBC (haematocrit)
- Total PSA
- Fasting plasma glucoseif needednon-French guidelineGlucose and metabolic tests to be considered before treatment and then at least once a year, especially in functional hypogonadism [1].
- Lipid profile (functional hypogonadism, risk factors)if needednon-French guidelineGlucose and metabolic tests to be considered before treatment and then at least once a year, especially in functional hypogonadism [1].
At 3, 6 and 12 months, then once a year
- Total testosterone (timing of the sample depends on the formulation used)
- FBC (haematocrit)
- Total PSA (at least once between 3 and 12 months, then according to the screening rules)
Sources (7)
- European Association of Urology (EAU). Guidelines on Sexual and Reproductive Health, chapitre « Male hypogonadism ». Édition 2026, consultée en ligne le 11 octobre 2026.
- Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 0357 (testostérone chez l'homme), 0358 (SHBG), 0701 (testostérone libre ou biodisponible), 0472 et 0473 (LH, FSH), 0343 (prolactine) et 7318 (PSA).
- Hackett G, Kirby M, Rees RW, Jones TH, Muneer A, Livingston M, et al. The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice. World J Mens Health. 2023;41(3):508-537.
- Heidelbaugh JJ, Belakovskiy A. Testosterone Replacement Therapy for Male Hypogonadism. Am Fam Physician. 2024;109(6):543-549.
- Healthy Male (Andrology Australia, financé par le ministère australien de la Santé). Androgen deficiency: clinical summary guide, guide de synthèse pour les médecins généralistes (relecture clinique : Dr Ie-Wen Sim, University of Melbourne), consulté le 29/10/2026.
- NHS South Yorkshire Integrated Care Board (Doncaster). Shared Care Guideline for topical (Testogel, Testavan) and injectable testosterone (Nebido) for adult male patients with hypogonadism, version 1.1, décembre 2025 (révision prévue en décembre 2027) : protocole local de soins partagés, fondé sur les recommandations de la BSSM et de la Society for Endocrinology.