Reflex strategy to ensure accurate total testosterone results from consumer initiated, self-collected capillary samples

Anissa R Naranjo; Matthew D Krasowski; Amal Hamdan; Kristin O'Connor; Claire Carter; Joyce Chen; Dina N Greene

doi:10.1016/j.cca.2024.119676

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Reflex strategy to ensure accurate total testosterone results from consumer initiated, self-collected capillary samples

Journal article

Open access

Peer reviewed

Reflex strategy to ensure accurate total testosterone results from consumer initiated, self-collected capillary samples

Anissa R Naranjo, Matthew D Krasowski, Amal Hamdan, Kristin O'Connor, Claire Carter, Joyce Chen and Dina N Greene

Clinica chimica acta, Vol.558, 119676

05/2024

DOI: 10.1016/j.cca.2024.119676

PMID: 38631605

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Abstract

Self-collected capillary samples are convenient for direct access testing (DAT), but exogenous testosterone use may cause falsely elevated total testosterone (TT) results. We designed a quality assurance workflow to differentiate between accurate or erroneous supraphysiological TT concentrations. Clinical samples with TT > 1500 ng/dL were reflexed to luteinizing hormone (LH) and follicle stimulating hormone (FSH) and screened for exogenous testosterone use. Samples (n = 120) with normal TT were reflexed to LH/FSH as a control. A total of 8572 TT samples were evaluated, of which 533 (6.2 %) had TT > 1500 ng/dL and were reflexed. Of these, 441 (82.7 %) had significantly decreased LH/FSH (<0.85/<0.7mIU/mL, respectively), 72 (13.5 %) had normal or borderline normal LH/FSH, and 20 (3.8 %) had insufficient plasma volume. In patients with TT > 1500 ng/dL, injectable exogenous testosterone use was most commonly accompanied by significantly decreased LH/FSH, while topical testosterone use was most commonly accompanied by detectable LH/FSH. Control samples were almost all (99.2 %) within or above the LH/FSH reference intervals. Unique patients ordered 351 TT tests where at least one TT result was > 1500 ng/dL. Based on TT and LH/FSH results, we hypothesized that patients were intermittently or consistently overusing exogenous testosterone, resolved elevated TT with recollection, or repeatedly contaminated their sample. Self-collected capillary specimens are acceptable for TT testing. A quality assurance reflex to LH/FSH can determine the validity of supraphysiological TT results in a consumer initiated/DAT population.

Consumer initiated testing

Testosterone

Capillary

Gonadotropins

Contamination

Details

Title: Subtitle: Reflex strategy to ensure accurate total testosterone results from consumer initiated, self-collected capillary samples
Creators: Anissa R Naranjo - LetsGetChecked Laboratories, Monrovia, CA, United States
Matthew D Krasowski - University of Iowa
Amal Hamdan - LetsGetChecked Laboratories, Monrovia, CA, United States
Kristin O'Connor - LetsGetChecked Laboratories, Monrovia, CA, United States
Claire Carter - LetsGetChecked Laboratories, Monrovia, CA, United States
Joyce Chen - LetsGetChecked Laboratories, Monrovia, CA, United States
Dina N Greene
Resource Type: Journal article
Publication Details: Clinica chimica acta, Vol.558, 119676
DOI: 10.1016/j.cca.2024.119676
PMID: 38631605
NLM abbreviation: Clin Chim Acta
ISSN: 0009-8981
eISSN: 1873-3492
Language: English
Electronic publication date: 04/15/2024
Date published: 05/2024
Academic Unit: Pathology
Record Identifier: 9984616954602771

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