dromlakhani Avoid testosterone measurement during acute illness
STEP 1 — Gather Information
Assess for acute illness: fever, active infection, hospitalization, or other acute medical decompensation; note symptoms and timing relative to planned testosterone draw.
STEP 2 — Rule In / Rule Out
Is the patient currently experiencing an acute illness? If yes, proceed to Step 3; if no, obtain serum testosterone in the morning fasting state and interpret per usual thresholds.
STEP 3 — Classify or Stratify
Classify the clinical scenario as "acute illness present" – testosterone measurement should be deferred; "no acute illness" – proceed to testing.
STEP 4 — Decide
If acute illness is present, delay testosterone measurement until the patient has recovered and is clinically stable; if no acute illness, draw testosterone between 07:00–11:00 hours in fasting state and use results for hypogonadism evaluation.
Clinical Guardrails / Mimics / Pitfalls
Do not interpret low testosterone obtained during acute illness as indicative of true hypogonadism; avoid initiating testosterone therapy based on such results; do not repeat testing during illness expecting normalization; remember that acute illness suppresses the HPG axis transiently.
Concrete Clinical Example
A 58‑year‑old man with type 2 diabetes presents with fever and productive cough for 2 days; he asks whether his testosterone should be checked now. The clinician defers testing until his respiratory infection resolves, then obtains a morning fasting testosterone level.
Source: Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), Khera et al., 2025, https://doi.org/10.1093/sxmrev/qeaf036