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How doctors evaluate patients who may benefit from testosterone replacement therapy

The diagnosis of testosterone deficiency is based on the patient’s history, the doctor’s examination and the results of the blood tests.

Since there are diseases that occur more commonly in older men that may be associated with testosterone deficiency syndrome (TDS), a thorough and appropriate work-up is essential in order to make a diagnosis and to treat men with TDS. It must be emphasised that before testosterone supplementation is initiated, there should be a reasonable indication based on the clinical picture, biochemical evidence of low testosterone levels (results from blood tests) and no contraindications to the use of testosterone replacement therapy.

The doctor will evaluate the signs and symptoms (see article on symptoms of TDS).
1. A complete record history of the patient’s general and sexual health is essential not only for making a diagnosis, but also for follow-up.
2. The doctor will check for any possible contraindications for testosterone supplementation. For example a history of breast or prostate cancer means that a man cannot be prescribed testosterone.
3. The doctor will perform a full clinical examination including a digital rectal examination (DRE). Patients may feel that that you are being over-examined, but a responsible doctor is just doing his/her job well.
4. Your doctor will send you for blood tests to check for:
4.1 Levels of testosterone and related hormones.
4.2 Possible prostate problem by doing a Prostate-specific antigen test (PSA).
4.3 Type II diabetes.
4.4 Thyroid problems.

NB When your major complaint is erectile dysfunction, your physician will refer you to a cardiologist for assessment of the blood supply to the heart muscle. Please follow the physician’s recommendations.

In most cases your doctor will be able to make a diagnosis based on your history, the findings on examination and the results of the blood tests. (Some tests may be repeated if the findings were not conclusive).

By Prof Riana Bornman (MB ChB, DSc Physiology, MD Physiology) Sept 2015

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