Testosterone Therapy in Men With Hypogonadism

Publication Date: March 17, 2018

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

Diagno...

...agnosis of Hypogonadism...

...agnosis of Men with Suspected Hypog...

...ine Society (ES) recommends diagno...

...Case Detection for Hypogonadism...

...commends against routine screening of men in the...

...guishing Between Primary or Second...

...ve hypogonadism, ES recommends distinguishing...

...ion for Determining the Etiology of Hypogonadism...

...th hypogonadism, ES suggests further evalu...


...le 1. Classification of Hypogonadism and Causes of...


.... Symptoms and Signs Suggestive of...


...Conditions in Which Measurement of FT Concentr...


...n Approach for the Diagnostic Evaluation of Adu...


Treatment

...reatme...

...ment of Hypogonadism with Test...

...ommends testosterone therapy in hypog...

...ecommends against testosterone therapy in men pl...

...s who choose monitoring, clinicians...

...al men being considered for testosterone therap...


...h Age-Related Decline in Testoster...

...ts against routinely prescribing testos...

...men >65 years who have symptoms o...


...ed Men with Weight Loss...

...suggests that clinicians consider...


...n with Type 2 Diabetes...

...e 2 diabetes mellitus who have low test...


...Conditions in Which T Administrat...


.... Clinical Pharmacology of T Formul...


...Testosterone Formulations Available Out...


Table 7. Potential Adverse Effects of T Repl...


Monitoring

...nitoring

...itoring of Testosterone Replacement...

...pogonadal men who have started testosterone ther...

...urological consultation for hypogonadal men recei...


...8. Monitoring Men Receiving T Ther...