Which lab tests should be performed in the evaluation of hypopituitarism (panhypopituitarism) in men?

Updated: Jun 09, 2020
  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

In men, measuring testosterone levels is useful, if properly performed. A decreased testosterone level should be associated with an increase in FSH and LH levels if pituitary function is normal. Low or normal FSH or LH levels in the face of low testosterone indicate hypopituitarism. Serum testosterone is best measured early in the morning owing to a diurnal rhythm that falls through the day. There may be other causes of a low testosterone level, such as poor nutrition, stress, hyperprolactinemia, or chronic opioid use. A low level of sex hormone binding protein may give a low total testosterone level (but with the free testosterone level being normal). A finding of low total testosterone needs to be confirmed with a repeat test, which should include a measurement of non-protein-bound (free) testosterone.

Semen analysis also may be performed. A normal semen sample usually excludes hypogonadism from a primary or secondary source. Semen analysis is performed only if fertility is being considered.


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