INTERPRETATION We found weak correlation between signs , symptoms and testosterone levels , uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition .
It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men
BACKGROUND Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men .
We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men .
Differences between univariate and bivariate models for summarizing diagnostic accuracy may not be large.
OBJECTIVE Experts recommend r and om effects bivariate logitnormal sensitivity and specificity estimates , rather than directly summarized univariate likelihood ratios ( LRs ) for diagnostic test meta-analyses . We assessed whether bivariate measures might cause different clinical conclusions compared with those from simpler univariate measures . STUDY DESIGN From two articles that described the benefits of bivariate r and om effects measures , we reanalyzed results and compared outcomes to univariate r and om effects summary estimates of sensitivity , specificity , and LRs . We also reanalyzed data from two published clinical examination studies to assess differences in the two methods . RESULTS The median difference between bivariate and univariate methods for sensitivity was 1.5 % ( range : 0 - 6 % ) and for specificity was 1.5 % ( range : 0 - 4 % ) . Using a pretest probability of 50 % , the median difference in posterior probability was 2.5 % ( interquartile range : 2.2 - 3.2 % , overall range : 0 - 11 % ) . For sparse data , continuity adjustment affected the differences . Adding 0.5 to each cell of studies containing at least one cell with zero patients provided the most consistent result . CONCLUSIONS Bivariate estimates of sensitivity and specificity generate summary LRs similar to those derived with univariate methods . Our empiric results suggest that recalculating LRs in published research will not likely create dramatic changes as a function of the r and om effects measure chosen
INTERPRETATION We found weak correlation between signs , symptoms and testosterone levels , uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition .
It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men
BACKGROUND Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men .
We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men .