androgen insufficiency (hypoandrogenism, testosterone deficiency)
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Introduction
Also see andropause, hypogonadism.
Etiology
- hypogonadism
- orchidectomy
- pharmaceuticals
- estrogen therapy
- opioids
- high-dose glucocorticoids
- Klinefelter's syndrome
- hypopituitarism
- testicular feminization
- hepatic cirrhosis
- andropause*
- levels drop in men with children
* 40% of men > 45 years of age[4]
Clinical manifestations
- incomplete or delayed sexual development[4]
- diminished libido
- diminished spontaneous erections
- breast discomfort, gynecomastia
- loss of axillary & pubic hair, diminished beard growth
- very small or shrinking testes (< 5 mL)
- infertility
- loss of height, evidence of osteoporosis
- hot flushes, sweats
- diminished sense of well-being
- decreased energy, motivation, initiative, self-confidence
- depression, dysthymia
- persistent & unexplained fatigue
- cognitive impairment
- inability to concentrate
- memory impairment
- sleep disturbance, hypersomnia
- reduced muscle bulk & muscle strength
- increased body fat, BMI
- diminished physical performance or work performance[4]
Laboratory
- normal serum estradiol
- diminished serum testosterone (AM measurement)
- free testosterone diminished
- not recommended unless method is equilibrium dialysis
- indicated if risk factors for diminished SHBG (obesity, older age)[4]
- free testosterone diminished
- serum LH & serum FSH to distinguish primary from secondary androgen insufficiency
- serum prolactin to assess pituitary disease
- complete blood count (not routine)
- mild anemia, normocytic, normochromic
- in normal range for female
- mild anemia, normocytic, normochromic
- sperm count may be low (not routine)
- may be indicated if fertility issues
Diagnostic procedures
Complications
- increased risk of cardiovascular disease
- increased risk of mortality in elderly men[11]
Differential diagnosis
Management
- androgen replacement recommended for symptomatic patients only[4][6]
- testosterone
- Estratest (women)
- confirmatory testing before treatment[4]
- screening not recommended[3]
More general terms
Additional terms
References
- ↑ Journal Watch 22(10):78, 2002 Bachmann G et al, Fertil Steril 77:660, 2002
- ↑ Guidelines on testosterone therapy in adult men with androgen deficiency syndromes (Endocrine Society) http://www.endo-society.org/quickcontent/clinicalpractice/clinical-guidelines/upload/AndrogensMenGuideline053006.pdf
- ↑ 3.0 3.1 Bhasin S et al, Testosterone therapy in adult men with androgen deficiency syndromes: An endocrine society clinical practice guideline. J Clin Endocrin Metab 2006; 91:1995 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16720669 corresponding NGC guideline withdrawn Feb 2016
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2013, 2015, 2018.
- ↑ Internal Medicine News, July 2005, pg 1,22
- ↑ 6.0 6.1 Bhasin S, Cunningham GR, Hayes FJ et al Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20525905
- ↑ Wierman ME, Basson R, Davis SR et al Androgen therapy in women: an Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab. 2006 Oct;91(10):3697-710. Epub 2006 Oct 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17018650 (corresponding NGC guideline revised 10/15)
Wierman ME, Arlt W, Basson R et al Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014 Oct;99(10):3489-510 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25279570 - ↑ Bhasin S et al. Testosterone therapy in men with androgen deficiency syndromes: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010 Jun; 95:2536. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20525905 <Internet> http://content.nejm.org/cgi/content/full/NEJMoa1000485
- ↑ Corona G, Vignozzi L, Sforza A, Maggi M. Risks and benefits of late onset hypogonadism treatment: an expert opinion. World J Mens Health. 2013 Aug;31(2):103-25. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24044106 Free PMC Article
- ↑ Paduch DA, Brannigan RE, Fuchs EF et al The laboratory diagnosis of testosterone deficiency. Urology. 2014 May;83(5):980-8. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24548716
- ↑ 11.0 11.1 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
- ↑ Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 Mar 17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29562364
- ↑ O'Rourke TK Jr, Wosnitzer MS. Opioid-Induced Androgen Deficiency (OPIAD): Diagnosis, Management, and Literature Review. Curr Urol Rep. 2016 Oct;17(10):76. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27586511