American Urological Association Clinical Low-T Diagnosis Guidelines 2018

Posted by Dr. Michael White, Updated on February 18th, 2024
Reading Time: 4 minutes

To provide the best possible HRT Care, available treatments must be prescribed with the latest in medical research in mind.

Earlier this month, the American Urological Association released updated guidelines regarding the diagnosis and treatment of Low-T and the ongoing assessment of men taking Prescription Testosterone.

While Testosterone Deficiency is a widespread medical issue, it is essential to make sure that Testosterone is only prescribed to those that have a demonstrative need for Hypogonadism Treatment.

It is best practices for patients taking Testosterone to undergo periodic evaluation. Still, this part of the process is frequently overlooked, which may be detrimental to the long-term care of the patient.

American Urological Association Guidelines have been released as the result of over 500 articles published over the last 40 years. A primary design goal of these guidelines was to assess the medical support of various claims regarding Bio-Identical Testosterone Therapy.

What is the Minimum Threshold for Testosterone Deficiency Diagnosis?

While the normal range for Testosterone is considered to be between 270-1,070 ng/dl, the American Urological Association suggests that only patients below 300 ng/dL be regarded as candidates for Low-T Treatment, while leaving some room for discretion by the prescribing Testosterone Doctor.

Ideally, Total Testosterone Concentrations should be measured at least twice before reaching a Low-T Diagnosis.

Also, Low Testosterone Levels alone should not be considered sufficient evidence of Testosterone Deficiency — the patient should also show symptoms of the Hormonal Condition.

Who Should Undergo Low-T Evaluation?

Testosterone Deficiency is not only the result of aging, but a variety of other lifestyle factors, medical events, and health history.

The American Urological Associated suggests further investigation of Low Testosterone Levels for patients under the following circumstances:

  • Low Libido
  • Sexual Insufficiency
  • Diabetes
  • Loss of Bone Mineral Density
  • Chronic Use of Corticosteroids or Narcotics
  • Prior Radiation or Chemotherapy
  • Pituitary Abnormalities
  • Anemia

What Tests Should be Performed in Conjunction With Low-T Analysis?

When monitoring for Testosterone Deficiency, it's essential to investigate other underlying issues that can help reveal the source of diminishing Testosterone Levels.

In particular, it is essential to measure Luteinizing Hormone Levels because this secretagogue is a crucial Testosterone Precursor. HRT Doctors should also monitor Prolactin Levels along with Luteinizing Hormone.

If Prolactin Levels are elevated, this is a sign that Low-T is likely the result of another underlying Endocrine Disorder.

For safety reasons, patients should have Hemoglobin, and Red Blood Cell Count monitored, because Testosterone Injections, Creams, and Patches can lead to Polycythemia (elevated RBC Concentration).

The American Urological Association recommends against the prescription of Alkylated Oral Testosterone because of the risk of side-effects associated with liver toxicity.

What Should Doctors Let Their Patients Know Before They Suggest Low-T Therapy as an Option?

Potential Testosterone Therapy Patients must be fully informed about the benefits and drawbacks of Bio-Identical Testosterone.

It's also important to differentiate between conclusively proven benefits and potential benefits that have not been sufficiently proven at this time.

The American Urological Association recommends that Hormone Doctors and Endocrinologists tell their patients about the correlation between heart disease and Low-T.

Men should also be informed that Bio-Identical Testosterone can provide relief from depression and anemia, improve body composition, enhance sexual desire and function, and increase Bone Mineral Density.

On the other hand, they should also be adequately informed that there is insufficient evidence to prove that Testosterone improves Cholesterol Levels, increases energy, diminishes fatigue, enhances cognition, or reduces diabetic issues.

Shortly, it is very likely that these benefits will manifest more clearly, but for now, the evidence isn't available in an appropriate volume.

What is the Ultimate Therapeutic Goal of Testosterone Therapy?

The American Urological Association recommends that Testosterone Levels be increased to the middle of the normal range for optimal treatment with the minimized risk of side effects.

By bringing Testosterone Levels up to this threshold, it's possible to provide patients with significant benefits.

To ensure that the treatment is providing the desired results and to monitor progress, Testosterone Levels should be reassessed either 1-2 times per year to make sure that the patient is maintaining ideal Serum Testosterone (not too high/too low).

If, after 3-6 months of treatment, the patient doesn't see noticeable results, doctors should suggest that the patient quit taking Testosterone.

Men Looking to Conceive Should Not Take Testosterone — Other HRT Options Available

Men that are concerned with maintaining fertility should not be given Testosterone Therapy. Taking Testosterone for an extended period significantly reduces fertility.

Bio-Identical Testosterone Treatments can vastly diminish the concentrations of essential Testosterone Precursors necessary for optimal fertility, leading to temporary practical infertility. For these patients, Selective Estrogen Receptor Modulators, HCG Injections, and Aromatase Inhibitors can all enhance Testosterone Levels without the use of an Exogenous Testosterone Supply.

Who Should Avoid Testosterone?

At this time, certain men should avoid Testosterone until further evidence proves its safety in exceptional cases. For example, patients at high risk of Prostate Cancer should not take Testosterone.

A Prostate-Specific Antigen (PSA) Test should be conducted before Testosterone Therapy Treatment. Also, there is insufficient evidence regarding the effect of Testosterone Therapy on patients that have experienced traumatic cardiovascular events in the past.

Talk to your General Practitioner or Hormone Specialist for more details.


Evaluation and Management of Testosterone Deficiency



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