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US Anti-Doping Agency
Philosophical issue is the establishment of minimal criteria for diagnosis of hypogonadism. An athlete
may manipulate blood testosterone levels (total and free) by use of anabolic steroids or other
medications (narcotics, corticosteroids) . The information requested to support a TUE is intended to
eliminate the possibility of this type of manipulation to present as a case of hypogonadism. The athlete
must have a confirmed diagnosis and bona fide etiology of hypogonadism, and the onus is on the athlete
to provide information necessary to establish the diagnosis and the organic (disease-related) etiology of
hypogonadism on the first TUE submission.
1. Medical Condition
a. Male Hypogonadism 1: A clinical syndrome resulting from the failure of the testis to
produce sufficient levels of testosterone to maintain normal physiological function. This
may result from disruption of the hypothalamic-pituitary-gonadal axis at various levels.
Primary hypogonadism failure reflects a disease of testis that impairs normal testicular
function resulting in low testosterone production, impairment of spermatogenesis, and
a compensatory elevation of gonadotropin levels, e.g. an anorchid male or man with
Klinefelter syndrome. Secondary hypogonadism reflects a disease of the pituitary gland
or hypothalamus that results in low or inappropriately normal gonadotropin and low
testosterone levels, e.g. pituitary adenoma or Kallmann syndrome.
2. Diagnosis
a. Medical History and Physical Examination (examples):
1. Incomplete sexual development, reduced sexual desire (libido) and activity,
decreased spontaneous erections, loss of male-pattern hair pattern, small or
shrinking testes size, height loss due to vertebral compression fracture, low
bone mineral density (osteopenia or osteoporosis), and reduced muscle bulk
and strength.
2. The athlete must not have a short term illness or other condition that would
influence testosterone production at the time of evaluation.
b. Routes of Administration
Intramuscular injections, transdermal (scrotal or non-scrotal skin testosterone patch,
testosterone gel or cream), oral testosterone (in some countries), testosterone
implants, and transbuccal testosterone tablets.
c. Frequency
As required for the route of administration to maintain serum testosterone levels within
the normal range.
6. Treatment Monitoring
a. Require athlete agree to random blood testing and be available.
b. Maintain formal record of when treatment is administered and dose.
c. Record of number of prescriptions.
9. References
1
Task Force. Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society
Clinical Practice Guideline. J Clin Endocrinol Metab 91: 1995-2010, 2006
2
Task Force. Androgen Therapy in Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol
Metab 91: 3697-3716, 2006