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.
- estosterone (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
...agnosis...
...nosis of Hypogonadism in Me...
...gnosis of Men with Suspected Hyp...
...Society (EST) and/or free testosterone...
...reening and Case Detection for...
ES recommends against routine scre...
...nguishing Between Primary or Secondary...
...hypogonadism, ES recommends distinguishin...
...r Determining the Etiology of Hypogon...
...th hypogonadism, ES suggests further eval...
Table 1. Classification of Hypogonadism a...
...mptoms and Signs Suggestive of T Def...
...3. Conditions in Which Measurement...
...ure 1. An Approach for the Diagnostic Evaluation...
Treatment
...atment...
...nt of Hypogonadism with Testosterone...
...S recommends testosterone therapy in hypogonadal...
...recommends against testosterone therapy...
...o choose monitoring, clinicians sho...
...onadal men being considered for te...
...der Men with Age-Related Decline in Testostero...
...ggests against routinely prescribing testostero...
...ars who have symptoms or conditions suggesti...
...-Infected Men with Weight Loss
...ts that clinicians consider short-...
...Type 2 Diabetes Mellitus...
...h type 2 diabetes mellitus who have low te...
...ons in Which T Administration Is Associat...
Table 5. Clinical Pharmacology of T Formulations...
...e 6. Testosterone Formulations Avail...
...ial Adverse Effects of T ReplacementHa...
Monitoring
Monitoring
...of Testosterone Replacement Therapy...
...dal men who have started testosterone therapy,...
...urological consultation for hypogonadal men re...
...ble 8. Monitoring Men Receiving T TherapyHavi...