How do I install the Icsm Testosterone Threshold Loh skill?

Run npx skillmds@latest add dromlakhani/icsm-testosterone-threshold-loh 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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Is Icsm Testosterone Threshold Loh free to use?

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Who published Icsm Testosterone Threshold Loh?

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

Icsm Testosterone Threshold Loh by dromlakhani

Name: Icsm Testosterone Threshold Loh
Rating: 4.2 (5 reviews)
Author: dromlakhani

Icsm Testosterone Threshold Loh

This skill applies a total testosterone threshold of less than 12 nmol/L (3.5 ng/mL) to diagnose late-onset hypogonadism. It is triggered when a clinician evaluates a testosterone result and questions whether the level is low enough to diagnose hypogonadism or what cutoff defines low T.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Apply testosterone threshold for late-onset hypogonadism diagnosis

STEP 1 — Gather Information

Obtain a morning (07:00–11:00) fasting total testosterone level using a reliable assay and assess for symptoms suggestive of LOH such as low libido, decreased morning erections, or erectile dysfunction.

STEP 2 — Rule In / Rule Out

Is the total testosterone level <12 nmol/L (3.5 ng/mL)? If yes, proceed to step 3; if no, consider LOH unlikely based on this threshold and evaluate other causes of symptoms.

STEP 3 — Classify or Stratify

Repeat total testosterone measurement on a separate occasion; if the second result is also <12 nmol/L, confirm biochemical LOH; if not, treat as transient low and reconsider diagnosis or repeat testing.

STEP 4 — Decide

If confirmed low testosterone (<12 nmol/L on two occasions) and LOH‑related symptoms are present, diagnose late‑onset hypogonadism and discuss testosterone therapy after reviewing risks and benefits; if symptoms are absent, generally refrain from initiating therapy based solely on low T.

Clinical Guardrails / Mimics / Pitfalls

Do not diagnose LOH on a single low testosterone; avoid testing during acute illness; do not ignore SHBG and albumin in men with clear dysmetabolic conditions when calculating free testosterone; do not start testosterone therapy without confirming low T on two separate occasions; do not treat asymptomatic men solely on the basis of a low total testosterone level.

Concrete Clinical Example

A 58‑year‑old man presents with decreased libido and fewer morning erections. His morning total testosterone is 10.8 nmol/L. A repeat test one week later shows 11.2 nmol/L. Both values are below 12 nmol/L, and he reports relevant symptoms, leading to a diagnosis of late‑onset hypogonadism and a discussion about testosterone therapy.

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

TODO: consider adding scripts/calc.py for the icsm-testosterone-threshold-loh calculator

---name: icsm-testosterone-threshold-lohdescription: This skill applies a total testosterone threshold of less than 12 nmol/L (3.5 ng/mL) to diagnose late-onset hypogonadism. It is triggered when a clinician evaluates a testosterone result and questions whether the level is low enough to diagnose hypogonadism or what cutoff defines low T.---# Apply testosterone threshold for late-onset hypogonadism diagnosis## STEP 1 — Gather InformationObtain a morning (07:00–11:00) fasting total testosterone level using a reliable assay and assess for symptoms suggestive of LOH such as low libido, decreased morning erections, or erectile dysfunction.## STEP 2 — Rule In / Rule OutIs the total testosterone level <12 nmol/L (3.5 ng/mL)? If yes, proceed to step 3; if no, consider LOH unlikely based on this threshold and evaluate other causes of symptoms.## STEP 3 — Classify or StratifyRepeat total testosterone measurement on a separate occasion; if the second result is also <12 nmol/L, confirm biochemical LOH; if not, treat as transient low and reconsider diagnosis or repeat testing.## STEP 4 — DecideIf confirmed low testosterone (<12 nmol/L on two occasions) and LOH‑related symptoms are present, diagnose late‑onset hypogonadism and discuss testosterone therapy after reviewing risks and benefits; if symptoms are absent, generally refrain from initiating therapy based solely on low T.## Clinical Guardrails / Mimics / PitfallsDo not diagnose LOH on a single low testosterone; avoid testing during acute illness; do not ignore SHBG and albumin in men with clear dysmetabolic conditions when calculating free testosterone; do not start testosterone therapy without confirming low T on two separate occasions; do not treat asymptomatic men solely on the basis of a low total testosterone level.## Concrete Clinical ExampleA 58‑year‑old man presents with decreased libido and fewer morning erections. His morning total testosterone is 10.8 nmol/L. A repeat test one week later shows 11.2 nmol/L. Both values are below 12 nmol/L, and he reports relevant symptoms, leading to a diagnosis of late‑onset hypogonadism and a discussion about testosterone therapy.**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> **TODO:** consider adding scripts/calc.py for the icsm-testosterone-threshold-loh calculator

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