hypogonadism
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Classification
- primary hypogonadism: testicular insufficiency
- secondary hypogonadism: hypothalamic/pituitary insufficiency
Etiology
Epidemiology
- testosterone changes in men with aging do not result in symptomatic hypogonadism in most men
Pathology
- both androgen & estrogen deficiency may play a role in male hypogonadism or sexual function
- sperm production may be diminished
Genetics
- implicated genes: LHB
Clinical manifestations
- infertility
- pseudohermaphroditism
- male
- decreasing libido
- erectile dysfunction
- small testes
- signs of feminization if prolonged
- poor sleep, poor concentration
- decreased muscle strength, stamina, energy, less facial hair
- signs/symptoms more subtle when reproductive failure occurs after pubertal development
Laboratory
- serum testosterone < 100 ng/mL (200 mg/dL[1]) (8 AM)
- two 8 AM serum testosterone measurements[1]
- free testosterone* in obese patients
- total serum testosterone may be affected by a decrease in plasma sex hormone-binding globulin (SHBG)[1]
- serum testosterone > 350-400 mg/dL excludes hypogonadism[1]
- repeat 8 AM serum testosterone reasonable if serum testosterone < 400 mg/dL[1]
- if testosterone low, measure serum luteinizing hormone (LH) & serum follicle-stimulating hormone (FSH)
- increased levels with primary gonadal failure
- diminished levels with secondary gonadal failure
- see ARUP consult[2]
* also measure free testosterone in patients with
- diabetes, nephrotic syndrome, hypothyroidism, acromegaly, & in patients taking steroids or progestins (decreased serum SHBG)
- older age, HIV1 infection, cirrhosis & hepatitis, hyperthyroidism, & in patients taking certain anticonvulsants or those taking estrogen (increased serum SHBG)[9]
Complications
- increased risk of mortality in elderly men[7]
Management
- determine cause before treatment[1]
- testosterone replacement therapy
- goal of mid-normal serum testosterone[1]
- avoid in men planning for fertility (impairs spermatogenesis)
- screening men with non-specific symptoms not recommended[1]
More general terms
More specific terms
Additional terms
- androgen insufficiency (hypoandrogenism, testosterone deficiency)
- erectile dysfunction (ED)
- impotence
- infertility
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2022.
- ↑ 2.0 2.1 ARUP Consult: Male Hypogonadism The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/hypogonadism-male
Hypogonadism Testing Algorithm https://arupconsult.com/algorithm/hypogonadism-testing-algorithm - ↑ Traish AM, Miner MM, Morgentaler A, Zitzmann M. Testosterone deficiency. Am J Med. 2011 Jul;124(7):578-87. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21683825
- ↑ Finkelstein JS et al Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men. N Engl J Med 2013; 369:1011-1022. September 12, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24024838 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1206168
Handelsman DJ Mechanisms of Action of Testosterone - Unraveling a Gordian Knot. N Engl J Med 2013; 369:1058-1059. September 12, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24024843 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1305307 - ↑ Wu FCW et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010 Jul 8; 363:123 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20554979
- ↑ Traish AM. Adverse health effects of testosterone deficiency (TD) in men. Steroids. 2014 Oct;88:106-16. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24942084
- ↑ 7.0 7.1 Pye SR, Huhtaniemi IT, Finn JD et al Late-onset hypogonadism and mortality in aging men. J Clin Endocrinol Metab. 2014 Apr;99(4):1357-66. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24423283
- ↑ Basaria S. Male hypogonadism. Lancet. 2014 Apr 5;383(9924):1250-63. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24119423
- ↑ 9.0 9.1 Sargis RM, Davis AM Evaluation and Treatment of Male Hypogonadism. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. JAMA. Published online March 17, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29550857 https://jamanetwork.com/journals/jama/fullarticle/2675569
- ↑ Karavolos S, Reynolds M, Panagiotopoulou N et al Male central hypogonadism secondary to exogenous androgens: a review of the drugs and protocols highlighted by the online community of users for prevention and/or mitigation of adverse effects. Clin Endocrinol (Oxf). 2015 May;82(5):624-32. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25333666