Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- suspected pituitary tumour with concerning features including:
- acute new visual field loss (usually temporal and classically bitemporal superior quadrantinopia/hemianopia)
- thunderclap headache
- symptomatic cortisol insufficiency
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
Northern Adelaide Local Health Network
- Lyell McEwin Hospital
(08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
- unexplained fatigue without endocrine disorder
Category 1 - appointment clinically indicated within 30 days
- arrested puberty (16 years and over)
- suspected hypopituitarism
Category 2 — appointment clinically indicated within 90 days
- confirmed hypogonadism with two morning testosterone levels less than 6nmol/l
- delayed puberty (16 years and over)
- male infertility
Category 3 — appointment clinically indicated within 365 days
- symptoms of androgen deficiency with testosterone levels above 6nmol/l
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- past medical/surgical/reproductive history, including:
- age and health
- drug therapy, including previous prescribed or non-prescribed testosterone
- testicular size
- current medications and dosages
- use/frequency of alcohol, tobacco, and other drugs, including:
- history of marijuana use (including partner)
- other relevant medications that contribute to infertility e.g. illicit drugs, steroids, chemotherapy
- allergies and sensitivities
- onset, duration, and progression of symptoms
- management history including treatments trialled/implemented prior to referral
- physical examination
- body mass index (BMI)
- morning sample on at least 2 separate days (7.00 to 9.00 am):
- luteinizing hormone (LH)
- follicle-stimulating hormone (FSH)
- androgen profile
- morning cortisol (8.00 to 9.00 am)
- thyroid stimulating hormone (TSH)
- free thyroxine (FT4)
- insulin-like growth factor-1 (IGF1)
- semen analysis
- repeat in 4 to 6 weeks if abnormal
Suspected obstructive sleep apnoea
- sleep study
Additional information to assist triage categorisation
- bone mineral densitometry
Clinical management advice
Hypogonadism can be caused by issues with the testicles (primary hypogonadism), the pituitary gland or hypothalamus (secondary hypogonadism), or a combination of factors. Treatment may involve hormone replacement therapy to raise testosterone levels and alleviate symptoms. Reduced testosterone levels can be associated with obesity, sleep apnoea, analgesics, alcohol and depression.
- Primary hypogonadism characterised by low testosterone, elevated luteinizing hormone and follicle- stimulating hormones, are indicative of primary testicular disease.
- Secondary hypogonadism involving low testosterone without increases in luteinizing hormone and follicle-stimulating hormones, indicates pituitary or hypothalamic dysfunction.
Investigation should establish persistent biochemical testosterone deficiency (requires at least 2 serum testosterone levels at 0800-0900 on separate days) to establish a diagnosis/cause.
- biochemical androgen deficiency, perform the recommended preliminary biochemical tests.
For testosterone treatment subsidised by the Pharmaceutical Benefits Scheme (PBS), an initial prescription should come from an endocrinologist, with patients having two morning testosterone levels below 6nmol/L in the presence of established pituitary or gonadal conditions. Treatment can be managed by a general paediatrician, endocrinologist, urologist, or a fellow of the Australasian Chapter of Sexual Health Medicine, or in consultation with one of these specialists.
Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.
Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.
Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.
- Endocrine Society: Clinical Practice Guideline - Testosterone Therapy In Men With Hypogonadism
- Therapeutic Guidelines - Male Androgen Deficiency