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DESCRIPTIONTestosterone is an endogenous androgen. Androgens are responsible for normal growth and development of male sex organs. Testosterone is produced by the testes and is involved in the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution (e.g., beard, pubic, chest and axillary hair); laryngeal enlargement, vocal cord thickening, and alterations in body musculature and fat distribution. In women, small amounts of testosterone are produced by the ovaries and adrenal glands. As in men, testosterone is thought to influence pubertal development, sexual function, bone density, muscle mass, erythropoiesis, energy, cognitive function, and mood in women.
Free Testosterone Measurement in Males
In short, obese men may have a low total serum testosterone concentration because of a combination of low SHBG and secondary hypogonadism. Measurement of the serum free testosterone concentration is necessary to determine if an obese man’s low total testosterone is due only to low SHBG or to secondary hypogonadism as well. Measurement of the serum free testosterone concentration is worthwhile only when it is suspected that an abnormality in testosterone binding to sex hormone-binding globulin coexists with hypogonadism. Measurement of the serum free testosterone in a laboratory capable of performing this assay accurately will distinguish between a binding abnormality and hypogonadism in an obese male.
Free Testosterone Measurement in Females
If serum free testosterone is measured, the following points should be kept in mind:
POLICYMeasurement of serum free testosterone is considered medically necessary to distinguish between a sex hormone-binding globulin (SHBG) abnormality and hypogonadism in obese males with symptoms of hypogonadism (See Policy Guidelines) if the total serum testosterone level is low.
Measurement of serum free testosterone is considered medically necessary to diagnose hyperandrogenism in symptomatic females (See Policy Guidelines).
Measurement of serum free testosterone is considered medically necessary in patients with a medical diagnosis that may increase or decrease SHBG levels (See Policy Guidelines).
Measurement of serum free testosterone is considered not medically necessary to diagnose testosterone deficiency in non-obese males with symptoms of hypogonadism.
Measurement of serum free testosterone is considered not medically necessary when performed for screening purposes in asymptomatic patients (absence of signs, symptoms, or disease).
POLICY GUIDELINESSymptoms hypogandism in males covered under this policy are malaise, fatigue, lethargy, hot flashes, muscle loss, depression, or decreased libido. If the only symptom is Erectile Dysfunction or Impotence, the laboratory testing is not covered.
Symptoms of overproduction of androgens in females include the following:
Medical diagnoses affected SHBG levels include the following:
Benefits will not be provided for the following contract exclusions:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY10/01/2013: New policy added.
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.