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Highlights & Basics
- Hypogonadism in men may present with reproductive/sexual clinical features (e.g., incomplete pubertal development, subfertility, gynecomastia), as well as nonreproductive features (e.g., fatigue, anemia, osteoporosis, loss of motivation or concentration, irritability, low or labile mood, body image concerns).
- Patients may have additional symptoms due to mass effects when hypogonadism is caused by large parasellar lesions (e.g., headache, peripheral visual disturbance), or may have signs or symptoms of other hormone deficiencies.
- Early morning fasting serum total testosterone level <300 nanograms/dL on at least two separate occasions in a man with one or more clinical features confers the diagnosis of hypogonadism in most cases.
- Measurement of the gonadotropins (luteinizing hormone [LH], follicle-stimulating hormone [FSH]) distinguishes between a primary cause (dysfunction of the testes) and a secondary (also known as central or hypogonadotropic) cause (pituitary or hypothalamic dysfunction).
- Management of men with low testosterone due to nongonadal illness (e.g., obesity) is to optimize treatment of the underlying condition.
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Jayasena CN, Anderson RA, Llahana S, et al. Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clin Endocrinol (Oxf). 2022 Feb;96(2):200-19.[Abstract][Full Text]
Matsumoto AM. Diagnosis and evaluation of hypogonadism. Endocrinol Metab Clin North Am. 2022 Mar;51(1):47-62.[Abstract]
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 May 1;103(5):1715-44.[Abstract][Full Text]
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