How do I install the Icsm Calculated Free Testosterone skill?

Run npx skillmds@latest add dromlakhani/icsm-calculated-free-testosterone in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Icsm Calculated Free Testosterone free to use?

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Who published Icsm Calculated Free Testosterone?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Icsm Calculated Free Testosterone by dromlakhani

Name: Icsm Calculated Free Testosterone
Rating: 4.2 (5 reviews)
Author: dromlakhani

Icsm Calculated Free Testosterone

This skill suggests measuring albumin and SHBG to calculate free testosterone in men with clear dysmetabolic conditions to improve diagnostic accuracy. It is triggered when managing a patient with obesity, diabetes, or metabolic syndrome and questioning whether to calculate free testosterone or obtain SHBG and albumin.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Consider albumin and SHBG for calculated free testosterone

STEP 1 — Gather Information

Collect total testosterone (morning fasting sample), serum albumin, and SHBG; assess for presence of clear dysmetabolic conditions (obesity, type 2 diabetes mellitus, metabolic syndrome).

STEP 2 — Rule In / Rule Out

Is the patient a man with a clear dysmetabolic condition (obesity, T2DM, or MetS)? If yes, proceed to calculate free testosterone; if no, rely on total testosterone alone for hypogonadism assessment.

STEP 3 — Classify or Stratify

Calculate free testosterone using the Vermeulen equation (or validated calculator) with total testosterone, SHBG, and albumin values.

STEP 4 — Decide

If calculated free testosterone is below the diagnostic threshold (e.g., <225 pmol/L), consider testosterone therapy; if normal, investigate other causes of symptoms.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on total testosterone in dysmetabolic patients; do not calculate free testosterone without measuring albumin and SHBG; avoid calculated free testosterone in acute illness or non‑dysmetabolic men; do not use calculated free testosterone to screen asymptomatic individuals.

Concrete Clinical Example

A 55‑year‑old man with obesity (BMI 32) and type 2 diabetes presents with low libido and fatigue. Total testosterone is 10.8 nmol/L (borderline). Albumin is 40 g/L and SHBG is 20 nmol/L. Calculated free testosterone via Vermeulen equation is 180 pmol/L (<225 pmol/L), confirming hypogonadism and prompting consideration of testosterone therapy.

Source: Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), International Society for Sexual Medicine, 2025, DOI: 10.1093/sxmrev/qeaf036

TODO: consider adding scripts/calc.py for the icsm-calculated-free-testosterone calculator

---name: icsm-calculated-free-testosteronedescription: This skill suggests measuring albumin and SHBG to calculate free testosterone in men with clear dysmetabolic conditions to improve diagnostic accuracy. It is triggered when managing a patient with obesity, diabetes, or metabolic syndrome and questioning whether to calculate free testosterone or obtain SHBG and albumin.---# Consider albumin and SHBG for calculated free testosterone## STEP 1 — Gather InformationCollect total testosterone (morning fasting sample), serum albumin, and SHBG; assess for presence of clear dysmetabolic conditions (obesity, type 2 diabetes mellitus, metabolic syndrome).## STEP 2 — Rule In / Rule OutIs the patient a man with a clear dysmetabolic condition (obesity, T2DM, or MetS)? If yes, proceed to calculate free testosterone; if no, rely on total testosterone alone for hypogonadism assessment.## STEP 3 — Classify or StratifyCalculate free testosterone using the Vermeulen equation (or validated calculator) with total testosterone, SHBG, and albumin values.## STEP 4 — DecideIf calculated free testosterone is below the diagnostic threshold (e.g., <225 pmol/L), consider testosterone therapy; if normal, investigate other causes of symptoms.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on total testosterone in dysmetabolic patients; do not calculate free testosterone without measuring albumin and SHBG; avoid calculated free testosterone in acute illness or non‑dysmetabolic men; do not use calculated free testosterone to screen asymptomatic individuals.## Concrete Clinical ExampleA 55‑year‑old man with obesity (BMI 32) and type 2 diabetes presents with low libido and fatigue. Total testosterone is 10.8 nmol/L (borderline). Albumin is 40 g/L and SHBG is 20 nmol/L. Calculated free testosterone via Vermeulen equation is 180 pmol/L (<225 pmol/L), confirming hypogonadism and prompting consideration of testosterone therapy.**Source:** Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), International Society for Sexual Medicine, 2025, DOI: 10.1093/sxmrev/qeaf036> **TODO:** consider adding scripts/calc.py for the icsm-calculated-free-testosterone calculator

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