Clinical inquiries. What screening tests should you use to evaluate a man with low testosterone?

756 VOL 57, NO 11 / NOVEMBER 2008 THE JOURNAL OF FAMILY PRACTICE FAST TRACK Experts recommend a repeat morning testosterone level, plus testing levels of FSH, LH, and prolactin to evaluate the cause of low testosterone Obtain a repeat morning testosterone level, as well as levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin to help understand the cause of low testosterone when there is a lack of adequate empiric evidence to guide evaluation, advise the experts. When low or normal FSH and LH levels accompany low testosterone, evaluation of the pituitary gland is recommended. Chromosomal studies are indicated in prepubertal males with low testosterone and elevated FSH and LH levels to assess for Klinefelter syndrome. Perform a semen analysis if fertility is an issue. Bone densitometry is indicated in men with chronic hypogonadism to identify increased risk of hip fracture (strength of all recommendations: C, consensus guidelines and disease-oriented evidence). Evidence-based answer