| name | icsm-avoid-tt-in-eugonadal |
| description | This skill advises against initiating testosterone therapy in eugonadal men with normal serum testosterone and no symptoms of deficiency. It is triggered when a clinician questions whether to prescribe testosterone for a patient with normal labs and no hypogonadal symptoms, such as asking 'should I give testosterone to someone with normal T?' or 'is treatment appropriate for eugonadal men?' |
Do not treat eugonadal men with testosterone therapy
STEP 1 — Gather Information
Obtain morning fasting total testosterone level and assess for symptoms of testosterone deficiency (low libido, erectile dysfunction, decreased morning erections, fatigue, depressed mood). Document level and symptom presence.
STEP 2 — Rule In / Rule Out
If total testosterone ≥12 nmol/L (≥350 ng/dL) AND patient reports no symptoms of hypogonadism, rule out testosterone therapy and proceed to Step 3; otherwise, proceed to Step 3 to evaluate for treatment.
STEP 3 — Classify or Stratify
Classify the patient as either "Eugonadal asymptomatic" (no treatment) or "Symptomatic hypogonadism" (candidate for testosterone therapy) based on the data gathered.
STEP 4 — Decide
For "Eugonadal asymptomatic", withhold testosterone therapy; for "Symptomatic hypogonadism", consider initiating testosterone therapy after shared decision‑making.
Clinical Guardrails / Mimics / Pitfalls
Do not treat based solely on low‑normal testosterone without symptoms; avoid using testosterone for non‑specific complaints like fatigue or depressed mood without confirmed deficiency; if therapy is inadvertently started, monitor hematocrit to prevent polycythemia.
Concrete Clinical Example
A 52‑year‑old man presents for a wellness visit; his morning total testosterone is 14 nmol/L (403 ng/dL) and he denies low libido, erectile dysfunction, or fatigue. He asks whether a testosterone booster would help his energy. According to the skill, testosterone therapy is not indicated.
Source: Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), International Society for Sexual Medicine, 2025, https://doi.org/10.1093/sxmrev/qeaf036
