Table 6. Recommendations – diagnosis.

Recommendatios for the diagnosis of restosterone deficiency	LoE	Grade
Restrict the diagnosis of TD to men with persistent symptoms suggesting TD and confirmed low testosterone	3	C
Measure (ideally fasting) testosterone levels in the morning before 11 am, acknowledging that, in normal life, non-fasting levels may be up to 30% lower	2	A
Repeat total testosterone on at least 2 occasions by a reliable method. In addition, measure free testosterone in men with levels close to the lower normal range (8–14 nmol/L) or those with suspected or known abnormal SHBG	1	A
Measure LH serum levels to differentiate between primary and secondary TD	2	A
Base decisions on therapy on published action levels rather than laboratory reference ranges	4	B

TD: testosterone deficiency, SHBG: sex hormone binding globulin, LH: luteinizing hormone.