Symptoms are of course important, in some scenarios paramount.
But, to take an obvious hypothetical, if a guy presents with generalised "lethargy", and "sexual disinterest", but a series of bloods show he is well within range on all appropriate hormones...why would a doctor prescribe him trt?
Now, if his bloods were marginally within range, in the absence of other objective measures/indicators I could see that being a decision of "discretion" by the treating physician. Some may be lenient and go ahead with trt, others may be more harder nosed and decline treatment.