Testosterone Therapy in Men With Hypogonadism
Key Points
Key Points
- Hypogonadism is a clinical syndrome that results from failure of the testis to produce physiological concentrations of testosterone (T deficiency) and/or a normal number of spermatozoa due to pathology at one or more concentrations of the hypothalamic-pituitary-testicular axis.
- Testosterone (T) deficiency can be due to testicular defects (primary hypogonadism), hypothalamus-pituitary defects (secondary hypogonadism) or both.
- Primary hypogonadism results in low T concentrations, impairment of spermatogenesis, and elevated gonadotropin levels. The causes of primary hypogonadism are listed in Table 1.
- Secondary hypogonadism results in low T concentrations, impairment of spermatogenesis, and low or inappropriately normal gonadotropin levels. Causes of secondary hypogonadism are listed in Table 1.
- Combined primary and secondary hypogonadism results in low T concentrations, impairment of spermatogenesis, and variable gonadotropin levels.
- Additionally, the process of evaluating secondary hypogonadism may uncover a deficiency/excess of other pituitary hormones or a hypothalamic or pituitary tumor that may require management in addition to treating hypogonadism
Diagnosis
Diagnos...
...iagnosis of Hypogonadism...
...osis of Men with Suspected Hypogonadism...
...ocrine Society (ES) recommends diagn...
...and Case Detection for Hypogonadism...
...ends against routine screening of men...
...ishing Between Primary or Secondary Hypog...
...en who have hypogonadism, ES recomme...
...Determining the Etiology of Hypogonadism...
...men with hypogonadism, ES suggests fur...
...ssification of Hypogonadism and Causes of Prima...
...2. Symptoms and Signs Suggestive o...
...itions in Which Measurement of FT Concentration i...
...ure 1. An Approach for the Diagnostic Ev...
Treatment
...atment
...Hypogonadism with Testosterone...
...mends testosterone therapy in hypogo...
...gainst testosterone therapy in men...
...ts who choose monitoring, clinicians should ass...
...men being considered for testosterone...
...ge-Related Decline in Testosterone...
...gainst routinely prescribing testosterone thera...
...n men >65 years who have symptoms or...
...nfected Men with Weight Lo...
...gests that clinicians consider short-term...
...ith Type 2 Diabetes Mellit...
...type 2 diabetes mellitus who have low tes...
...Conditions in Which T Administration Is As...
...ble 5. Clinical Pharmacology of T...
...tosterone Formulations Available Outside...
...otential Adverse Effects of T ReplacementHavin...
Monitoring
...itoring...
...ing of Testosterone Replacement Therapy
...ogonadal men who have started testo...
...a urological consultation for hypogonadal men re...
...able 8. Monitoring Men Receiving T TherapyHavin...