Contribution de la testostérone biodisponible aux explorations hormonales pour le diagnostic de l’andropause

The measurement of bioavailable testosterone (BT) is considered to be an essential analytical criterion for the diagnosis of male hypogonadism, but the reported normal values differ from one study to another and no consensus has been reached concerning the cut-off values for the diagnosis of androgen deficiency in aging males. Using the lower values measured in a group of clinically normogonadic men between the ages of 40 and 49 years, we have established our own cut-off values: 8 nmol/L for total testosterone and 3.5 nmol/L for BT. By applying these criteria to a group of 87 men with clinical symptoms of androgen deficiency, androgen deficiency was confirmed by laboratory assays in only 14% of these men based on total testosterone, but in 60% of men based on BT. The inverse correlation between BT and SHBG was confirmed regardless of the total testosterone level. SHBG assay is very useful for the diagnosis of androgen deficiency in a population of older males, but cannot replace direct measurement of BT for an accurate individual diagnosis.