Well one major issue is that hypogonadism isn't totally understood yet. Certainly the handful of doctors on any given commission's payroll aren't all experts in it.
So when some guy rolls up and his nuts aren't producing test as they should be... well, there could be a lot of reasons and it's very difficult to narrow it down. Specialists are expensive and time consuming. And at the end of the day I think guys like Kizer and Lembo are more than willing to just sort of best-guess it and in a lot of cases I think it just comes down to who plays their game properly.
Everybody good, plenty of slaves for my robot colony?