8 Further examination is performed as indicated by the history or age, with particular reference to the cardiovascular, neurological and endocrine systems. The minimum basic investigation is exclusion of diabetes mellitus. Other investigations to be performed if indicated by the history or examination are urea, creatinine and electrolytes and liver function tests. It is only mandatory to measure testosterone if hypogonadism is suspected. LH and FSH are measured if testosterone is low.
Prolactin is measured if testosterone is low or if there is loss of libido.
If testosterone treatment is contemplated PSA and a rectal examination should be performed as a baseline. Testosterone should not be used in eugonadal men as it may promote the growth of occult prostatic cancer. Patients who should be referred on for specialist opinion include young patients who have always had difficulty, patients with a history of trauma or patients with genital abnormalities. Appropriate advice is given about the correction of underlying risk factors. As sexual activity carries a degree of cardiovascular risk it is advisable to assess cardiovascular status before initiating treatment.