How do I install the Icsm Indications For Testosterone Assessment skill?

Run npx skillmds@latest add dromlakhani/icsm-indications-for-testosterone-assessment 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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Which AI agents work with Icsm Indications For Testosterone Assessment?

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 Indications For Testosterone Assessment free to use?

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Who published Icsm Indications For Testosterone Assessment?

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

Icsm Indications For Testosterone Assessment by dromlakhani

Name: Icsm Indications For Testosterone Assessment
Rating: 4.2 (5 reviews)
Author: dromlakhani

Icsm Indications For Testosterone Assessment

Recommends evaluating testosterone in men presenting with sexual symptoms (low libido, erectile dysfunction, decreased morning erections), metabolic conditions (obesity, type 2 diabetes, metabolic syndrome), HIV infection, opioid or glucocorticoid use, bone density loss, or male infertility. Triggers when a clinician encounters a patient with any of these indications and considers whether to check testosterone levels.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Assess clinical indications for testosterone measurement

STEP 1 — Gather Information

Collect history of sexual symptoms (libido, erectile dysfunction, morning erections), metabolic disease (BMI, HbA1c, waist circumference), HIV status, opioid/glucocorticoid use, bone health (prior fracture, osteoporosis), reproductive history (time trying to conceive, semen analysis), medication list, and perform physical exam focusing on testes size, body hair, gynecomastia.

STEP 2 — Rule In / Rule Out

Is there at least one indication from sexual symptoms, metabolic conditions, HIV, opioid/glucocorticoid use, bone density loss, or male infertility? If YES, proceed to testosterone measurement; if NO, routine testosterone screening is not recommended.

STEP 3 — Classify or Stratify

If the patient has clear dysmetabolic conditions (obesity, type 2 diabetes, metabolic syndrome), plan to measure SHBG and calculate free testosterone in addition to total testosterone; otherwise, total testosterone alone is sufficient for initial assessment.

STEP 4 — Decide

Order a morning (07:00–11:00) fasting total testosterone; if dysmetabolic conditions present, also order SHBG; if total testosterone <12 nmol/L on two separate occasions, consider testosterone therapy after excluding other causes; if normal, investigate alternative etiologies for symptoms.

Clinical Guardrails / Mimics / Pitfalls

Do not order testosterone in asymptomatic men or during acute illness; avoid relying on a single low result; do not initiate testosterone therapy solely for osteoporosis, depression, or cardiovascular risk reduction; remember that opioids and glucocorticoids can suppress testosterone independent of hypogonadism; ensure proper timing and fasting state for accurate measurement.

Concrete Clinical Example

A 58‑year‑old man with type 2 diabetes reports decreased libido and morning erections; history reveals no opioid use, normal bone density, and he is trying to conceive for 1 year; step 1 collects metabolic and sexual symptoms; step 2 indicates testing is warranted; step 3 adds SHBG due to diabetes; step 4 shows morning total testosterone 9 nmol/L (low) on two repeats, SHBG normal, leading to discussion of testosterone replacement therapy.

Source: Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), Mohit Khera et al., 2025, https://doi.org/10.1093/sxmrev/qeaf036

---name: icsm-indications-for-testosterone-assessmentdescription: Recommends evaluating testosterone in men presenting with sexual symptoms (low libido, erectile dysfunction, decreased morning erections), metabolic conditions (obesity, type 2 diabetes, metabolic syndrome), HIV infection, opioid or glucocorticoid use, bone density loss, or male infertility. Triggers when a clinician encounters a patient with any of these indications and considers whether to check testosterone levels.---# Assess clinical indications for testosterone measurement## STEP 1 — Gather InformationCollect history of sexual symptoms (libido, erectile dysfunction, morning erections), metabolic disease (BMI, HbA1c, waist circumference), HIV status, opioid/glucocorticoid use, bone health (prior fracture, osteoporosis), reproductive history (time trying to conceive, semen analysis), medication list, and perform physical exam focusing on testes size, body hair, gynecomastia.## STEP 2 — Rule In / Rule OutIs there at least one indication from sexual symptoms, metabolic conditions, HIV, opioid/glucocorticoid use, bone density loss, or male infertility? If YES, proceed to testosterone measurement; if NO, routine testosterone screening is not recommended.## STEP 3 — Classify or StratifyIf the patient has clear dysmetabolic conditions (obesity, type 2 diabetes, metabolic syndrome), plan to measure SHBG and calculate free testosterone in addition to total testosterone; otherwise, total testosterone alone is sufficient for initial assessment.## STEP 4 — DecideOrder a morning (07:00–11:00) fasting total testosterone; if dysmetabolic conditions present, also order SHBG; if total testosterone <12 nmol/L on two separate occasions, consider testosterone therapy after excluding other causes; if normal, investigate alternative etiologies for symptoms.## Clinical Guardrails / Mimics / PitfallsDo not order testosterone in asymptomatic men or during acute illness; avoid relying on a single low result; do not initiate testosterone therapy solely for osteoporosis, depression, or cardiovascular risk reduction; remember that opioids and glucocorticoids can suppress testosterone independent of hypogonadism; ensure proper timing and fasting state for accurate measurement.## Concrete Clinical ExampleA 58‑year‑old man with type 2 diabetes reports decreased libido and morning erections; history reveals no opioid use, normal bone density, and he is trying to conceive for 1 year; step 1 collects metabolic and sexual symptoms; step 2 indicates testing is warranted; step 3 adds SHBG due to diabetes; step 4 shows morning total testosterone 9 nmol/L (low) on two repeats, SHBG normal, leading to discussion of testosterone replacement therapy.**Source:** Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), Mohit Khera et al., 2025, https://doi.org/10.1093/sxmrev/qeaf036

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