Icsm Avoid Tt In Eugonadal

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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