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Low Testosterone Medscape CME Expert Column Series. Issue 2: Screening and Workup for Testosterone Deficiency

  • Authors: Martin M. Miner, MD
  • CME Released: 9/21/2011
  • Valid for credit through: 9/21/2012, 11:59 PM EST
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Target Audience and Goal Statement

This activity was developed for primary care physicians, nurse practitioners (NPs), and physician assistants (PAs).

Both symptoms and biochemical evidence of hypogonadism are prerequisites for the diagnosis and treatment of testosterone deficiency (TD). This principle presents a challenge to clinicians because the symptoms of TD are not specific to hypogonadism, and can, at best, raise suspicion of TD when they are present. National and international guidelines concur in recommending screening for TD in men considered at risk due to coexisting illnesses. The conditions include infertility, type 2 diabetes, metabolic syndrome, chronic obstructive pulmonary disease, inflammatory arthritis, cardiovascular disease, and chronic use of glucocorticoids and opioids. Clinicians should maintain a high index of suspicion of TD in patients with these comorbidities. Even those at-risk patients who report no symptoms typical of hypogonadism require a thorough clinical and biochemical workup for TD.

Total testosterone (TT) has been the traditional measure for use in corroboration of hypogonadism. However, values for “normal” testosterone vary among laboratories according to the assay in use. Even if assays were consistent, there is no clear clinically relevant dividing line between normal and deficient testosterone in the blood, despite the efforts of involved medical societies to define one.

The goals of this program are to improve recognition of candidates for TD screening, better understand the importance of associated comorbidities, and describe appropriate use of various laboratory tools for confirmation of a TD diagnosis.

Upon completion of this activity, participants should be able to:

  1. Identify men who are candidates for screening of TD, including those with nonspecific symptoms and associated comorbidities.
  2. Describe clinical and laboratory workup of men with suspected TD.
  3. Evaluate the meaning of laboratory findings in light of disparities in definition of low testosterone.


No off-label uses of any agent are discussed.

All activity faculty and planners participating in continuing medical education activities sponsored by New York Medical College are expected to disclose to the audience any significant support or substantial relationship(s) with providers of commercial products and/or devices discussed in this activity and/or with any commercial supporters of the activity. In addition, all faculty are expected to openly disclose any off-label, experimental, or investigational use of drugs or devices discussed in this activity. The faculty and planning committee have been advised that this activity must be free from commercial bias, and based upon all the available scientifically rigorous data from research that conforms to accepted standards of experimental design, data collection, and analysis.


  • Martin M. Miner, MD

    Clinical Associate Professor of Family Medicine and Urology, The Warren Alpert Medical School of Brown University, Co-director, Men’s Health Center, Chief of Family and Community Medicine, The Miriam Hospital, Providence, Rhode Island


    Disclosure: consultant: Abbott Laboratories, Endo Pharmaceuticals; consultant/researcher: Auxilium Pharmaceuticals Inc; researcher: GlaxoSmithKline.


The Planning Committee for this activity included Kathy Kavanagh, Director, and Margaret Astrologo, Assistant Director of New York Medical College; and Ruth Cohen, CCMEP, Vice President, CME Director, and Margaret Inman, Senior Editor of Continuing Education Alliance. The members of the Planning Committee have no significant relationships to disclose.

Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council For Continuing Medical Education (ACCME) through the joint sponsorship of New York Medical College (NYMC) and Continuing Education Alliance. NYMC is accredited by the ACCME to provide continuing medical education for physicians.

    New York Medical College designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s) . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. In addition, you must complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.


Low Testosterone Medscape CME Expert Column Series. Issue 2: Screening and Workup for Testosterone Deficiency

Authors: Martin M. Miner, MDFaculty and Disclosures

CME Released: 9/21/2011

Valid for credit through: 9/21/2012, 11:59 PM EST


This content is no longer available.

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