High-value laboratory testing in erectile dysfunction, reduced sexual desire, and suspected hypogonadism: analytical pitfalls and selective biomarker use

Lab review argues most ED workups over-order hormones and under-order glucose and lipids

Journal: Clinical Biochemistry | Published: 2026-06-16 | Type: Journal Article, Review | PMID: 42303206 Authors: Broul M (Dept. of Sexology, Masaryk Hospital, Ústí nad Labem); Kelbich P, Jizerová A, Partlová D, Hujová A, Liegertová M (Institute of Biomedicine and Laboratory Diagnostics, Jan Evangelista Purkyně University) Funding/COI: No funding listed. Authors declare no competing interests.

Summary

This is a lab-medicine opinion piece, not a data-generating study: a group of Czech clinical biochemists and one sexologist walk through which blood tests are actually worth ordering when a man presents with erectile dysfunction, low libido, or suspected low testosterone. Their pitch is that clinics either shotgun a full hormone panel or skip the metabolic tests that matter more, and that a smarter default is fasting glucose or HbA1c, a lipid panel, and a single early-morning fasting testosterone, with a second confirmatory testosterone draw before labeling someone hypogonadal. Prolactin, thyroid tests, and estradiol get relegated to specific clinical scenarios rather than routine ordering.

Claims

• Recommends a first-line panel of fasting glucose/HbA1c, lipid profile, and early-morning fasting testosterone for most men with ED (assuming no recent results exist)
• Says low or borderline testosterone should be confirmed on a second independent early-morning fasting sample before diagnosing androgen deficiency
• Advises calculated free testosterone with SHBG only "when indicated," not as a default add-on
• Flags that prolactin testing is prone to interference from macroprolactin and the assay hook effect, and should be reserved for select endocrine presentations
• Argues thyroid function tests and estradiol should be ordered based on phenotype, not reflexively bundled into every ED workup

Study Quality

This is a narrative review, not a systematic one — the abstract gives no search strategy, no inclusion criteria, no count of studies screened, and no quantitative synthesis. That's a legitimate format for a methods-and-stewardship piece aimed at lab practice, but it also means the recommendations rest on the authors' reading of the literature rather than a reproducible evidence-grading process. Five of six authors are laboratory/biomedicine specialists rather than clinicians who see these patients, which fits the paper's analytical-pitfalls focus but also means the guidance leans toward lab-side concerns (assay performance, preanalytical variables) over clinical decision-making context.

Red Flags

• No systematic search methodology described — can't assess how comprehensive or cherry-picked the underlying evidence base is
• No effect sizes, thresholds, or quantitative data in the abstract despite covering biomarkers where numeric cutoffs (testosterone ng/dL, HbA1c%) are clinically central
• Heavy lab-diagnostics authorship skew (5 of 6 authors) could bias emphasis toward analytical stewardship over clinical utility
• No funding disclosure beyond "not listed" — unclear if this was unfunded or simply undocumented

Strengths

• Targets a real, under-discussed problem: indiscriminate hormone panel ordering paired with underuse of glucose/lipid testing in ED workups
• Insists on confirmatory retesting for low testosterone before diagnostic labeling, consistent with major endocrine society guidance
• Explicitly calls out assay-specific pitfalls (macroprolactin, hook effect, preanalytical timing) that generic clinical reviews often skip
• No industry funding or disclosed conflicts of interest

Verdict

Useful if you're the clinician or lab ordering these tests, skippable if you're looking for new clinical evidence. This is a practice-stewardship review with no original data and no disclosed systematic methodology, so treat its recommendations as expert opinion from a lab-diagnostics group rather than an evidence synthesis you can cite for effect sizes or cutoffs.