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Highlights & Basics
- Hypogonadism in men may present with reproductive/sexual clinical features (e.g., incomplete pubertal development, infertility, gynecomastia), as well as nonreproductive features (e.g., fatigue, osteoporosis, loss of motivation or concentration, irritability, low or labile mood, body image concerns).
- Patients may have additional symptoms due to mass effects when 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 below 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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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]
European Association of Urology. EAU guidelines on sexual and reproductive health. 2024 [internet publication].[Full Text]
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