Materiały źródłowe

• #1 Male Hypogonadism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532933/

  Male hypogonadism, acquired or congenital, can be caused by defects that interfere with the hypothalamic-pituitary-testicular axis. It is essential to distinguish between primary hypogonadism and secondary hypogonadism. Symptoms highly suggestive of hypogonadism include decreased spontaneous erections, decreased nocturnal penile tumescence, decreased libido, and reduced testicular volume. […] The normal range for early morning testosterone in a male is generally between 300 ng/dL to 1000 ng/dL, although this varies by laboratory. Hypogonadism is usually diagnosed when the morning serum testosterone level is 300 ng/dL on at least 2 occasions. […] Initial laboratory testing should include 2 early morning (8 AM to 10 AM) serum testosterone measurements. Two total testosterone levels 300 ng/dL are generally considered sufficient to diagnose biochemical but not clinical male hypogonadism, although this may vary somewhat depending on the laboratory. The clinical diagnosis of male hypogonadism requires an associated symptom or sign of the disorder. Only patients with symptoms associated with clinical hypogonadism should be treated for low testosterone.

• #1 Male Hypogonadism | Choose the Right Test

  https://arupconsult.com/content/hypogonadism-male

  Male hypogonadism is defined as a failure, in individuals with testes, to produce either a normal concentration of testosterone or a normal number of spermatozoa. […] A diagnosis of hypogonadism requires both clinical signs or symptoms of testosterone deficiency and consistently low testosterone concentrations, as demonstrated by laboratory testing. […] Both signs and symptoms of testosterone deficiency and consistently low serum testosterone concentrations are needed for a diagnosis of functional hypogonadism. […] Testing for hypogonadism should be performed in individuals with testes who present with signs and symptoms of testosterone deficiency or who have conditions associated with testosterone deficiency (e.g., infertility, pituitary mass, use of opioids or glucocorticoids, and withdrawal from anabolic-androgenic steroids).

• #1 Low Testosterone (Low T): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism

  Low testosterone (male hypogonadism) is a condition in which your testicles dont produce enough testosterone. […] Its treatable with testosterone replacement therapy. […] The American Urology Association (AUA) considers low blood testosterone to be less than 300 nanograms per deciliter (ng/dL) for adults. […] However, some researchers and healthcare providers disagree with this and feel that levels below 250 ng/dL are low. Providers also take symptoms into consideration when diagnosing low testosterone. […] If you have signs and symptoms of low testosterone, a healthcare provider will perform a physical exam. […] To make a diagnosis, a provider will consider your specific signs, symptoms and any blood test results. […] The following tests can help confirm low testosterone and determine the cause: Total testosterone level blood test, Luteinizing hormone (LH) blood test, Prolactin blood test.

• #1 Male hypogonadism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/diagnosis-treatment/drc-20354886

  Early detection in boys can help prevent problems from delayed puberty. Early diagnosis and treatment in men offer better protection against osteoporosis and other related conditions. […] Your health care provider will conduct a physical exam and note whether your sexual development, such as your pubic hair, muscle mass and size of your testes, is consistent with your age. […] Your provider will test your blood level of testosterone if you have signs or symptoms of hypogonadism. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day, before 10 a.m., possibly on more than one day. […] If tests confirm that you have low testosterone, further testing can determine if a testicular disorder or a pituitary abnormality is the cause. These studies might include: Hormone testing, Semen analysis, Pituitary imaging, Genetic studies, Testicular biopsy.

• #1 Hypogonadism in men – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/1093

  Key diagnostic factors include decreased libido, loss of spontaneous morning erections, erectile dysfunction, gynaecomastia, infertility, micropenis, small testes, bifid or hypoplastic scrotum, cryptorchidism, especially if bilateral, segmental dysproportion, bitemporal hemianopia, low trauma fractures, loss of height, and anosmia. […] Other diagnostic factors include decreased energy and fatigue, absent or incomplete puberty, scrotal hypoplasia, hypopigmentation, and absent rugae, decreased muscle mass and strength, loss of axillary and pubic hair, lack of facial hair, poor concentration and memory, depressed or labile mood, sleep disturbance, hot flushes and sweats, tall stature, and fine wrinkling of facial skin. […] 1st investigations to order include serum total testosterone. […] Investigations to consider include serum sex hormone binding globulin (SHBG), calculated free testosterone, serum LH/FSH, semen analysis, FBC, serum prolactin, serum transferrin saturation and ferritin, MRI pituitary, genetic testing, and dual-energy x-ray absorptiometry (DEXA or DXA).

• #1 Assessment and management of male androgen disorders: an update

  https://www.racgp.org.au/afp/2014/may/male-androgen-disorders

  It is important to ask the patient about the age of onset of his problems, about congenital defects such as cryptorchidism, pubertal development, fertility, previous testicular trauma or infection, radiotherapy, chemotherapy, use of medications that inhibit androgen biosynthesis, and medical conditions that can cause both primary and secondary hypogonadism. […] The diagnostic approach to hypogonadism is summarised in Figure 1. […] It is very important to remember that an underlying aetiology should always be sought before testosterone therapy is considered. […] Testosterone replacement is recommended for symptomatic classical androgen deficiency syndromes after excluding contraindications in the initial work up. […] Testosterone therapy should not be started without a thorough work-up to delineate the underlying aetiology and identify associated pathologies.

• #1 Male Hypogonadism | Choose the Right Test

  https://arupconsult.com/content/hypogonadism-male

  The diagnosis of hypogonadism is established by laboratory confirmation of low testosterone in patients with signs and symptoms suggestive of hypogonadism. […] Total testosterone is the initial test for hypogonadism in individuals with testes. […] If low testosterone is confirmed in patients with signs and symptoms suggestive of hypogonadism, then a diagnosis of hypogonadism is established. […] Assessing the concentrations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can help differentiate between a diagnosis of primary hypogonadism and secondary hypogonadism. High serum LH and FSH concentrations indicate primary hypogonadism. Low or normal concentrations indicate secondary hypogonadism. […] For individuals with primary hypogonadism, consider karyotype testing to assess for Klinefelter syndrome, especially for those with a testicular volume of 6 mL. […] The recommended testosterone concentrations for diagnosis of hypogonadism and therapeutic goals of testosterone therapy vary by society guideline.

• #1 Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1472884/

  Hypogonadism can be of hypothalamic-pituitary origin or of testicular origin, or a combination of both, which is increasingly common in the aging male population. […] Before initiation of testosterone replacement therapy, an examination of the prostate and assessment of prostate symptoms should be performed, and both the hematocrit and lipid profile should be measured. […] To determine whether a patient is testosterone deficient, a clinician must consider clinical signs and symptoms in conjunction with laboratory values. […] Initial laboratory testing should include early morning (8:00-10:00 AM) measurement of serum testosterone, prolactin, FSH, and LH levels. […] In elderly men, testosterone levels decrease between 15% and 20% over the course of 24 hours. […] Total testosterone levels might be normal with hypogonadism if the SHBG levels are increased.

• #1 Clinical features and diagnosis of male hypogonadism – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-male-hypogonadism

  Clinical features and diagnosis of male hypogonadism […] The clinical features of male hypogonadism are sufficiently well recognized, the causes sufficiently well known, and the tests of the hypothalamic-pituitary-testicular axis sufficiently accurate to permit the diagnosis in most patients. […] This topic will review the major clinical features and diagnostic approach to hypogonadism in adult men. […] The distinction between these disorders, which will be described below, is made by measurement of the serum concentrations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH): […] The patient has primary hypogonadism if the serum testosterone concentration and/or the sperm count are below normal and the serum LH and/or FSH concentrations are above normal. […] The patient has secondary hypogonadism if the serum testosterone concentration and/or the sperm count are below normal and the serum LH and/or FSH concentrations are normal or low.

• #1 Hypogonadism Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/922038-workup

  For postpubertal males with total testosterone concentrations near the lower limit of the normal range, measurement of free or bioavailable testosterone using a reliable assay is suggested if there is suspicion of sex hormone binding globulin (SHBG) changes. […] Examination of seminal fluid, karyotyping, and testicular biopsy may be helpful. […] In prepubertal males with delayed puberty, priming with testosterone (usually testosterone enanthate 50 mg IM monthly for a total of 3 months) may lead to puberty initiation and help in the differential diagnosis of hypogonadotropic hypogonadism.

• #1 Male Hypogonadism – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/male-reproductive-endocrinology-and-related-disorders/male-hypogonadism

  To confirm secondary hypogonadism in adolescents, the GnRH stimulation test may be considered. […] If levels of FSH and LH increase in response to IV GnRH, puberty is simply delayed. […] If levels do not increase, true hypogonadism is likely. […] Diagnosis can be approached systematically, using an algorithm.

• #1 Hypogonadism Differential Diagnoses

  https://emedicine.medscape.com/article/922038-differential

  For adolescents with delayed puberty, the differential diagnosis is mainly between constitutional delay of puberty and hypogonadism. […] If hypogonadism is suspected, measurement of serum LH and FSH concentrations can be used to distinguish between hypogonadotropic and hypergonadotropic hypogonadism and guide further evaluation and management. Serum LH and FSH levels are elevated in cases of hypergonadotropic hypogonadism. […] Hypergonadotropic hypogonadism indicates a primary gonadal defect (congenital or acquired), while hypogonadotropic hypogonadism suggests a hypothalamic/pituitary process (congenital or acquired). […] A history of anosmia and/or the presence of microphallus raise concerns for the presence of hypogonadotropic hypogonadism. […] Turner syndrome should be considered in short females with absent sexual development. […] Arrested puberty in the presence of gynecomastia in a male raises concern for gonadal failure. Klinefelter syndrome needs to be ruled out in such cases.

• #1 Testosterone Deficiency Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

  1. The Evaluation and Management of Testosterone Deficiency AUA Guideline provides guidance to the practicing clinician on how to diagnose, treat and monitor the adult male with testosterone deficiency. […] 2. Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone. […] 3. The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion. […] 4. The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs. […] 5. Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even in the absence of symptoms or signs associated with testosterone deficiency.

• #1 Male Hypogonadism in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/male-hypogonadism-in-children

  Male hypogonadism is decreased production of testosterone, sperm, or both or, rarely, decreased response to testosterone, resulting in delayed puberty, infertility, or both. Diagnosis is by measurement of serum testosterone, luteinizing hormone, and follicle-stimulating hormone and by stimulation tests with human chorionic gonadotropin or gonadotropin-releasing hormone. […] Diagnosis of male hypogonadism in children is often suspected based on developmental abnormalities or delayed puberty but requires confirmation by testing, including measurement of testosterone, LH, and FSH. LH, and especially FSH, levels are more sensitive than testosterone levels, especially for detecting primary hypogonadism. Testing should be done in the morning and requires pediatric-specific assays (often labeled as ultrasensitive or immunochemiluminometric [ICMA]).

• #1 Assessment and management of male androgen disorders: an update

  https://www.racgp.org.au/afp/2014/may/male-androgen-disorders

  Older obese men with chronic comorbidities commonly present with non-specific symptoms and modestly low testosterone. […] The risk-benefit ratio of testosterone therapy in such men is less favourable than in men with organic androgen deficiency. […] Large, well-conducted clinical trials are needed to provide more evidence to guide clinicians and patients regarding the benefits, and risks, of testosterone therapy.

• #1 Laboratory diagnosis of late-onset male hypogonadism andropause – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/laboratory-diagnosis-of-late-onset-male-hypogonadism-andropause/

  Laboratory diagnosis of late-onset male hypogonadism andropause […] To evaluate which factors influence the laboratorial diagnosis of late-onset male hypogonadism (LOH). […] The laboratorial definition of LOH was two values of calculated free testosterone (cFT) 6.5 ng/dl, according to Vermeulens formula. […] Laboratorial LOH (confirmed by two tests) was present in 19%, but TT levels were low in only 4.1%. […] Age influenced TT (p=0.0051) as well as BMI; 23.5% of patients […] 70 years and 38.9% of the obese men who had TT within the reference range were, in fact, hypogonadal. […] Especially in obese men and in those […] 70 years old, SHBG dosage is important to calculate FT levels and diagnose hypogonadism.

• #1 Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1472884/

  If testosterone levels are low-normal but the clinical symptoms and signs indicate hypogonadism, measurement of serum total testosterone levels should be repeated and an SHBG level should be determined. […] In the postpubertal period, once the diagnosis of testosterone deficiency has been made, replacement therapy should be considered in light of the clinical signs and symptoms in conjunction with the laboratory values. […] An early morning total serum testosterone level of less than 300 ng/dL clearly indicates hypogonadism, and under most circumstances benefit will be derived from testosterone replacement therapy. […] Before initiation of testosterone replacement therapy, an examination of the prostate and assessment of prostate symptoms should be performed, and both the hematocrit and lipid profile should be measured.

• #1 Male Hypogonadism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532933/

  Monitoring: Pretreatment: Hemoglobin (Hgb), Hct, digital rectal exam (DRE), PSA level, 2 early morning testosterone levels, prolactin, FSH, and LH. […] The prognosis is excellent for symptomatic men diagnosed with male hypogonadism who are treated according to guidelines and followed appropriately. While the condition is not usually curable, it is amenable to treatment with clomiphene or testosterone replacement therapy.

• #1 Testosterone Deficiency Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

  24. Clinicians should measure an initial follow-up total testosterone level after an appropriate interval to ensure that target testosterone levels have been achieved. […] 25. Testosterone levels should be measured every 6-12 months while on testosterone therapy. […] 26. Clinicians should discuss the cessation of testosterone therapy three to six months after commencement of treatment in patients who experience normalization of total testosterone levels but fail to achieve symptom or sign improvement.

• #1 Hypogonadism – Wikipedia

  https://en.wikipedia.org/wiki/Hypogonadism

  Treatment is often prescribed for total testosterone levels below 230 ng/dL with symptoms. […] The standard range given is based on widely varying ages and, given that testosterone levels naturally decrease as humans age, age-group specific averages should be taken into consideration when discussing treatment between doctor and patient. […] A position statement by the Endocrine Society expressed dissatisfaction with most assays for total, free, and bioavailable testosterone. […] Screening males who do not have symptoms of hypogonadism is not recommended as of 2018. […] Male primary or hypergonadotropic hypogonadism is often treated with testosterone replacement therapy if they are not trying to conceive. […] Another treatment for hypogonadism is human chorionic gonadotropin (hCG). […] For both men and women, an alternative to testosterone replacement is low-dose clomifene treatment, which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects that can result from direct hormone replacement therapy.

• #1 Male hypogonadism and ageing: rejuvenating the guidance | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/131-spring19/society-news/male-hypogonadism-and-ageing-rejuvenating-the-guidance/

  A plethora of updated diagnostic guidelines have recently appeared that are notable for major differences of emphasis. […] The revised version is now freely available on the Societys website. […] Late-onset hypogonadism (LoH) was originally characterised as a clinical and biochemical syndrome associated with ageing-related co-morbidities (especially obesity), symptoms of testosterone deficiency and consistently low testosterone, after exclusion of classical causes of hypogonadism. […] The number of men with LoH by this original definition is small, with the European Male Ageing Study (EMAS) reporting only 2.1% of men aged greater than 40 years. […] We therefore emphasise the primacy of lifestyle interventions over testosterone treatment in men with borderline-low serum testosterone levels and low-normal LH, unless there are other compelling reasons, such as osteoporosis, anaemia, small testes or sexual dysfunction refractory to first line treatment. Importantly, a diagnosis of hypogonadism, at any age, is more secure when framed in the context of a recognised clinical syndrome.

• #1 Male Hypogonadism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532933/

  Asymptomatic hypogonadal patients do not require treatment. Only patients with symptoms possibly associated with low testosterone levels should be considered candidates for therapy. […] Clomiphene citrate is an effective therapy for both biochemical and clinical male hypogonadism through a unique mechanism of action. […] Testosterone therapy in proven hypogonadal men has been shown in clinical trials to produce statistically significant improvements in libido, anemia, bone mineral density, lean body mass, depression, and erectile function. […] The goal of therapy is to avoid exceeding the normal maximum testosterone blood level (which peaks 2 days after a testosterone injection) while maintaining normal serum androgen levels and adequately treating the instigating symptom, which may take up to 6 months. For most patients, this requires 100 mg of testosterone cypionate or enanthate once a week or the equivalent daily testosterone gel.

• #2 Male Hypogonadism | Choose the Right Test

  https://arupconsult.com/content/hypogonadism-male

  Male hypogonadism is defined as a failure, in individuals with testes, to produce either a normal concentration of testosterone or a normal number of spermatozoa. […] A diagnosis of hypogonadism requires both clinical signs or symptoms of testosterone deficiency and consistently low testosterone concentrations, as demonstrated by laboratory testing. […] Both signs and symptoms of testosterone deficiency and consistently low serum testosterone concentrations are needed for a diagnosis of functional hypogonadism. […] Testing for hypogonadism should be performed in individuals with testes who present with signs and symptoms of testosterone deficiency or who have conditions associated with testosterone deficiency (e.g., infertility, pituitary mass, use of opioids or glucocorticoids, and withdrawal from anabolic-androgenic steroids).

• #2 Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1472884/

  Hypogonadism can be of hypothalamic-pituitary origin or of testicular origin, or a combination of both, which is increasingly common in the aging male population. […] Before initiation of testosterone replacement therapy, an examination of the prostate and assessment of prostate symptoms should be performed, and both the hematocrit and lipid profile should be measured. […] To determine whether a patient is testosterone deficient, a clinician must consider clinical signs and symptoms in conjunction with laboratory values. […] Initial laboratory testing should include early morning (8:00-10:00 AM) measurement of serum testosterone, prolactin, FSH, and LH levels. […] In elderly men, testosterone levels decrease between 15% and 20% over the course of 24 hours. […] Total testosterone levels might be normal with hypogonadism if the SHBG levels are increased.

• #2 Testosterone Therapy: Review of Clinical Applications | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p441.html

  Although there is no universal laboratory definition of hypogonadism, in most laboratory reference ranges, the lower limit of normal is between 250 and 350 ng per dL (8.7 to 12.2 nmol per L). […] If low testosterone is confirmed, luteinizing hormone and follicle-stimulating hormone levels should be measured to categorize the deficiency as primary or secondary. […] Testosterone measurement should be considered in older men with unexplained anemia. […] Men receiving testosterone therapy should be monitored regularly for adverse effects and treatment effectiveness, including testosterone measurements, complete blood count to measure hematocrit, and prostate-specific antigen testing. […] Most experts agree that the goal serum testosterone level should be in the midnormal range (i.e., 400 to 700 ng per dL [13.9 to 24.3 nmol per L]); values outside of this range require a dose adjustment.

• #2 Male Hypogonadism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532933/

  Male hypogonadism, acquired or congenital, can be caused by defects that interfere with the hypothalamic-pituitary-testicular axis. It is essential to distinguish between primary hypogonadism and secondary hypogonadism. Symptoms highly suggestive of hypogonadism include decreased spontaneous erections, decreased nocturnal penile tumescence, decreased libido, and reduced testicular volume. […] The normal range for early morning testosterone in a male is generally between 300 ng/dL to 1000 ng/dL, although this varies by laboratory. Hypogonadism is usually diagnosed when the morning serum testosterone level is 300 ng/dL on at least 2 occasions. […] Initial laboratory testing should include 2 early morning (8 AM to 10 AM) serum testosterone measurements. Two total testosterone levels 300 ng/dL are generally considered sufficient to diagnose biochemical but not clinical male hypogonadism, although this may vary somewhat depending on the laboratory. The clinical diagnosis of male hypogonadism requires an associated symptom or sign of the disorder. Only patients with symptoms associated with clinical hypogonadism should be treated for low testosterone.

• #2 Male Hypogonadism: Causes, Symptoms, and Treatment

  https://www.verywellhealth.com/male-hypogonadism-8651069

  Male hypogonadism is diagnosed based on low testosterone blood levels and the appearance of symptoms. The process is not always straightforward and may require the input of a hormone specialist known as an endocrinologist to interpret the results. […] The diagnosis of male hypogonadism typically starts with a physical exam and a review of your medical and family histories. This may include a gloved examination of your scrotum, testicles, penis, and breasts. […] The most important tool for the diagnosis of hypogonadism is the serum testosterone test. This test measures the amount of testosterone in units of nanograms per deciliter of blood (ng/dL). In adult males, the normal range is between 300 and 1,000 ng/dL. […] According to guidelines issued by the American Urological Association (AUA), male hypogonadism can be diagnosed when all three of the following conditions are met: Two consecutive serum testosterone tests are under 300 ng/dL. The blood tests are taken on two separate occasions early in the morning when testosterone levels are at their highest. There is at least one symptom of hypogonadism.

• #2 Diagnosis and Evaluation of Male Hypogonadism

  https://www.medscape.org/viewarticle/575491

  Male hypogonadism should be diagnosed only in men who have clinical signs and symptoms that are consistent with androgen deficiency, and biochemical androgen deficiency confirmed by unequivocally low serum T levels. […] The clinical presentation of male hypogonadism depends on the stage of development during which androgen deficiency occurs. […] Clinical findings that are suggestive of adult male hypogonadism may be classified as sexual manifestations (ED, infertility, and shrinking or very small [especially less than 5 mL] testes); brain/behavioral manifestations (reduced libido, hot flushes, and sweating); and physical manifestations (breast discomfort; gynecomastia; loss of axillary, pubic, and facial hair; and, with more severe, long-standing androgen deficiency, low bone mineral density [BMD], low trauma fracture, and reduced muscle bulk and strength).

• #2 Male Hypogonadism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23268

  Secondary hypogonadism (pituitary failure) is characterized by low serum testosterone with normal or low LH levels. […] Both primary and secondary hypogonadism can cause significant abnormalities in sperm count and semen analyses. […] Karyotype testing should be performed in young adults to rule out conditions such as Turner and Klinefelter syndromes, which can result in testosterone deficiency. […] Symptoms highly suggestive of androgen deficiency in men include reduced sexual desire, decreased spontaneous erections, fatigue, lethargy, loss of axillary and pubic hair, visual field changes (such as bitemporal hemianopsia), loss of smell (anosmia), declining or small testicular volume, hot flashes, and infertility with low or absent sperm counts. […] A physical examination should identify the presence of bilateral testes and measure their size.

• #2 Hypogonadism: Types, Causes, Symptoms, Treatment, Outlook

  https://www.healthline.com/health/hypogonadism

  How is hypogonadism diagnosed? A doctor will conduct a physical exam to confirm your sexual development is typical for a person your age. They may examine your muscle mass, body hair, and sexual organs. […] If the doctor thinks you might have hypogonadism, theyll first check the levels of your sex hormones. […] Youll need a blood test so that they can check your level of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Your pituitary gland makes these reproductive hormones, which are also known as gonadotropins. […] If youre AMAB, youll have your testosterone levels tested. Testosterone tests are usually performed in the morning when your hormone levels are highest. The doctor may also order a semen analysis to check your sperm count. Hypogonadism can reduce your sperm count.

• #2 Clinical features and diagnosis of male hypogonadism – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-male-hypogonadism

  Clinical features and diagnosis of male hypogonadism […] The clinical features of male hypogonadism are sufficiently well recognized, the causes sufficiently well known, and the tests of the hypothalamic-pituitary-testicular axis sufficiently accurate to permit the diagnosis in most patients. […] This topic will review the major clinical features and diagnostic approach to hypogonadism in adult men. […] The distinction between these disorders, which will be described below, is made by measurement of the serum concentrations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH): […] The patient has primary hypogonadism if the serum testosterone concentration and/or the sperm count are below normal and the serum LH and/or FSH concentrations are above normal. […] The patient has secondary hypogonadism if the serum testosterone concentration and/or the sperm count are below normal and the serum LH and/or FSH concentrations are normal or low.

• #2 Hypogonadism and Low Testosterone in Men: Laboratory Support of Diagnosis and Management | Clinical Focus | Quest Diagnostics Hypogonadism and Low Testosterone in Men: Laboratory Support of Diagnosis and Management Hypogonadism and Low Testosterone in Men

  https://testdirectory.questdiagnostics.com/test/test-guides/CF_Male_Hypgonadism/hypogonadism-and-low-testosterone-in-men-laboratory-support-of-diagnosis-and-management

  If TT is near the lower limit of normal or alterations in SHBG are suspected such that TT is affected, guideline recommendations include measuring free testosterone (FT). […] For men with hypogonadism who have started testosterone replacement therapy (TRT), laboratory testing involves monitoring testosterone, hematocrit, prostate-specific antigen (PSA), and bone mass density (BMD). […] Testosterone treatment can lead to secondary erythrocytosis (hematocrit >54%), which is associated with risk of cardiovascular mortality and morbidity. […] A diagnosis of male hypogonadism can only be made in patients with symptoms of hypogonadism and unequivocal (ie, repeated a second time) low TT and/or FT. […] FT should be measured if conditions associated with changes in SHGB are present in a patient. […] High LH and FSH levels are characteristic of primary hypogonadism (hypergonadotropic hypogonadism) in men. Low or low to normal LH and FSH levels are associated with secondary hypogonadism (hypogonadotropic hypogonadism).

• #2 Male Hypogonadism: Causes, Symptoms, and Treatment

  https://www.verywellhealth.com/male-hypogonadism-8651069

  To help narrow the list of causes of hypogonadism, your healthcare provider will order blood tests to measure follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These are hormones produced by the pituitary gland that stimulate the production of sperm cells and testosterone. […] When taken together: Low testosterone with high FSH and LH levels indicates primary hypogonadism. Low testosterone with normal to low FSH and LH indicates secondary hypogonadism.

• #2 Hypogonadism in men – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/1093

  Key diagnostic factors include decreased libido, loss of spontaneous morning erections, erectile dysfunction, gynaecomastia, infertility, micropenis, small testes, bifid or hypoplastic scrotum, cryptorchidism, especially if bilateral, segmental dysproportion, bitemporal hemianopia, low trauma fractures, loss of height, and anosmia. […] Other diagnostic factors include decreased energy and fatigue, absent or incomplete puberty, scrotal hypoplasia, hypopigmentation, and absent rugae, decreased muscle mass and strength, loss of axillary and pubic hair, lack of facial hair, poor concentration and memory, depressed or labile mood, sleep disturbance, hot flushes and sweats, tall stature, and fine wrinkling of facial skin. […] 1st investigations to order include serum total testosterone. […] Investigations to consider include serum sex hormone binding globulin (SHBG), calculated free testosterone, serum LH/FSH, semen analysis, FBC, serum prolactin, serum transferrin saturation and ferritin, MRI pituitary, genetic testing, and dual-energy x-ray absorptiometry (DEXA or DXA).

• #2 Male Hypogonadism – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/male-reproductive-endocrinology-and-related-disorders/male-hypogonadism

  To confirm secondary hypogonadism in adolescents, the GnRH stimulation test may be considered. […] If levels of FSH and LH increase in response to IV GnRH, puberty is simply delayed. […] If levels do not increase, true hypogonadism is likely. […] Diagnosis can be approached systematically, using an algorithm.

• #2 Male Hypogonadism in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/male-hypogonadism-in-children

  Elevated serum FSH levels with normal serum testosterone and LH levels typically indicate impaired spermatogenesis but not impaired testosterone production. In primary hypogonadism, it is important to determine the karyotype to investigate for Klinefelter syndrome. […] Measurement of inhibin B and anti-mullerian hormone levels can help assess gonadal function in boys with suspected hypogonadism. […] The human chorionic gonadotropin (hCG) stimulation test is done to assess the presence and secretory ability of testicular tissue. […] Diagnose by measurement of testosterone, luteinizing hormone, and follicle-stimulating hormone levels.

• #2 Assessment and management of male androgen disorders: an update

  https://www.racgp.org.au/afp/2014/may/male-androgen-disorders

  Older obese men with chronic comorbidities commonly present with non-specific symptoms and modestly low testosterone. […] The risk-benefit ratio of testosterone therapy in such men is less favourable than in men with organic androgen deficiency. […] Large, well-conducted clinical trials are needed to provide more evidence to guide clinicians and patients regarding the benefits, and risks, of testosterone therapy.

• #2 MALE HYPOGONADISM AND TESTOSTERONE REPLACEMENT | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/143-spring-22/features/male-hypogonadism-and-testosterone-replacement/

  Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism have recently been published in Clinical Endocrinology. […] Many of us find male hypogonadism (MH) a difficult condition to diagnose and manage. […] For this reason, the Clinical Committee of the Society for Endocrinology commissioned us to develop new guidance for the UK, which we felt was best achieved through a multidisciplinary approach, comprising expertise from endocrinology (medical and nursing), primary care, clinical biochemistry, urology and reproductive medicine practices, and a patient expert. […] Not all cases of MH are equal. It is easy to diagnose primary hypogonadism (low testosterone level and raised gonadotrophins), but hypogonadotrophic or central MH may be difficult to distinguish from non-gonadal illness (NGI), and thus careful clinical correlation is required.

• #2 Testosterone Deficiency Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

  1. The Evaluation and Management of Testosterone Deficiency AUA Guideline provides guidance to the practicing clinician on how to diagnose, treat and monitor the adult male with testosterone deficiency. […] 2. Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone. […] 3. The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion. […] 4. The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs. […] 5. Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even in the absence of symptoms or signs associated with testosterone deficiency.

• #2 Adult Male Hypogonadism: A Laboratory Medicine Perspective on Its Diagnosis and Management

  https://www.mdpi.com/2075-4418/13/24/3650

  Testosterone (T), the principal androgen secreted by the testes, plays an essential role in male health. Male hypogonadism is diagnosed based on a combination of associated clinical signs and symptoms and laboratory confirmation of low circulating T levels. […] The British Society for Sexual Medicine (BSSM) and the European Association of Urology (EAU) guidelines on sexual dysfunction recommend that all men with ED should have, as a minimum standard, an initial measurement of T, and in those with a poor response to phosphodiesterase type 5 inhibitors (PDE5i), T should be rechecked. […] Diagnosis of hypogonadism in men is based upon the identification of its non-specific features through clinical assessment and blood testing. Serum total T is the most widely accepted biomarker to biochemically establish the presence of hypogonadism.

• #2 Male hypogonadism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/diagnosis-treatment/drc-20354886

  For male hypogonadism, some questions to ask your provider include: What tests do I need? […] Treatment of delayed puberty in boys depends on the cause. Three to six months of testosterone shots can help start puberty. The testosterone can help increase muscle mass, beard and pubic hair growth, and growth of the penis. This treatment is given only if the bones have matured enough.

• #2 Male Hypogonadism in Children – Children’s Health Issues – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/children-s-health-issues/hormonal-disorders-in-children/male-hypogonadism-in-children

  Hypogonadism is decreased production of testosterone, sperm, or both in males. […] The diagnosis is based on an examination, blood tests, and sometimes an analysis of the chromosomes. […] Doctors suspect the diagnosis of hypogonadism when a boy has developmental abnormalities or delayed puberty. […] To confirm the diagnosis, doctors do blood tests to measure the levels of testosterone, luteinizing hormone, and follicle-stimulating hormone. […] Doctors may do a chromosome analysis, especially if they suspect Klinefelter syndrome.

• #2 Male hypogonadism and ageing: rejuvenating the guidance | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/131-spring19/society-news/male-hypogonadism-and-ageing-rejuvenating-the-guidance/

  A plethora of updated diagnostic guidelines have recently appeared that are notable for major differences of emphasis. […] The revised version is now freely available on the Societys website. […] Late-onset hypogonadism (LoH) was originally characterised as a clinical and biochemical syndrome associated with ageing-related co-morbidities (especially obesity), symptoms of testosterone deficiency and consistently low testosterone, after exclusion of classical causes of hypogonadism. […] The number of men with LoH by this original definition is small, with the European Male Ageing Study (EMAS) reporting only 2.1% of men aged greater than 40 years. […] We therefore emphasise the primacy of lifestyle interventions over testosterone treatment in men with borderline-low serum testosterone levels and low-normal LH, unless there are other compelling reasons, such as osteoporosis, anaemia, small testes or sexual dysfunction refractory to first line treatment. Importantly, a diagnosis of hypogonadism, at any age, is more secure when framed in the context of a recognised clinical syndrome.

• #2 Male hypogonadism and ageing: rejuvenating the guidance | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/131-spring19/society-news/male-hypogonadism-and-ageing-rejuvenating-the-guidance/

  As LH-stimulated testosterone levels exhibit a circadian rhythm and are acutely lowered by oral carbohydrate intake, the biochemical fingerprint of true SH (low testosterone, with low or inappropriately normal LH level) can be artefactually reproduced by postprandial or afternoon venepuncture. Therefore, serum total testosterone levels should always be measured fasted before 11.00, preferably after a good nights sleep and not during intercurrent illness. […] Readings below the reference range on at least two different occasions support a diagnosis of hypogonadism, as do raised LH level (signalling PH), low bone density or anaemia. […] Testosterone treatment of men with a well-founded diagnosis of hypogonadism is effective and safe, and should not be withheld on the basis of age or disability.

• #2 SciELO Brazil – Laboratory diagnosis of late-onset male hypogonadism andropause Laboratory diagnosis of late-onset male hypogonadism andropause

  https://www.scielo.br/j/abem/a/kxRvwNMyBBLGm5ZCvqTxMbc/

  The gold standard for the laboratorial diagnosis of late-onset male hypogonadism was defined as a patient having two values of cFT 6.5 ng/dl obtained according to the Vermeulen formula, with a minimum interval between measurements of one month. […] The TT values in our study varied significantly based on age and BMI. The level of SHBG is especially important in calculating FT in patients 70 years of age or older and also for those patients with BMI 30 kg/m2. […] Calculated BT proved to be the best marker for the laboratory diagnosis of hypogonadism.

• #2 Low Testosterone (Low T): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism

  Healthcare providers treat low testosterone (male hypogonadism) with testosterone replacement therapy. […] You may not be able to receive testosterone replacement therapy if you have a history of prostate cancer, an unevaluated lump on your prostate, breast cancer, uncontrolled heart failure, or untreated obstructive sleep apnea. […] The side effects of testosterone replacement therapy include acne or oily skin, swelling in your ankles caused by mild fluid retention, stimulation of the prostate, breast enlargement or tenderness, worsening of sleep apnea, smaller testicles, and skin irritation. […] Laboratory abnormalities that can occur with testosterone replacement therapy include an increase in prostate-specific antigen (PSA), an increase in red blood cell count, and a decrease in sperm count, producing infertility.

• #2 Testosterone deficiency: diagnosis, assessment and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/testosterone-deficiency-diagnosis-assessment-and-treatment

  In the presence of symptoms, a TT level of <8 nanomol/L or a FT level of <180 picomol/L requires treatment. [...] Prior to starting TRT, patients should be assessed to rule out the contraindications listed in Box 3. [...] TD is associated with male infertility and can be diagnosed during investigations performed for infertility. In such patients, or in those who have a desire to have children, TRT should not be offered as first-line treatment. [...] If a significant and continuous rise in PSA is seen, notably above the age-specific range, a digital rectal examination should be carried out and the patient should be referred to a urologist for further investigations for prostate cancer. [...] TD can affect male psychological, sexual and physical health. Making a correct diagnosis can alleviate this and lead to an improvement in quality of life.

• #2 Testosterone Deficiency Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

  24. Clinicians should measure an initial follow-up total testosterone level after an appropriate interval to ensure that target testosterone levels have been achieved. […] 25. Testosterone levels should be measured every 6-12 months while on testosterone therapy. […] 26. Clinicians should discuss the cessation of testosterone therapy three to six months after commencement of treatment in patients who experience normalization of total testosterone levels but fail to achieve symptom or sign improvement.

• #2 Current National and International Guidelines for the Management of Male Hypogonadism: Helping Clinicians to Navigate Variation in Diagnostic Criteria and Treatment Recommendations

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2020.760

  All guidelines agree that the best way to measure T is by liquid chromatography mass spectrometry, but acknowledge that this may not be available in every institution and; hence, a high-quality validated immunoassay may instead need to be relied upon. […] All guidelines affirm that testosterone replacement is indicated with a verified diagnosis of MH, i.e., the presence of characteristic symptoms combined with the unequivocal biochemical finding of low T. […] Current national and international guidelines relating to MH are remarkably heterogeneous in respect of diagnostic, treatment and monitoring criteria.

• #2 Adult Male Hypogonadism: A Laboratory Medicine Perspective on Its Diagnosis and Management

  https://www.mdpi.com/2075-4418/13/24/3650

  When circulating T levels are borderline or low upon first measurement, the test should be repeated on at least two occasions (ideally after a period of four weeks), as T is released in a pulsatile manner, and the result of a single assay may be misleading. […] At present, there is no definitive reference range or LLN threshold value for serum T that can be used to reliably and accurately identify men with hypogonadism; in part, this is because hypogonadal symptoms manifest at varying levels between individuals and because of the variation in results between T immunoassays and their associated reference ranges. […] Improvements in the standardisation of T assays and the consistency of reporting between laboratories are required. If abnormal results are found and confirmed, discussion with or referral to a specialist endocrinology clinic should be considered.

• #2 How to manage low testosterone level in men: a guide for primary care | British Journal of General Practice

  https://bjgp.org/content/70/696/364

  Secondary (or central) hypogonadism (SH) is characterised by low testosterone with low-to-normal LH and FSH levels. SH is caused by impaired hypothalamo-pituitary function and, hence, serum ferritin and pituitary hormone profile plus imaging is warranted. […] Primary care physicians can confidently diagnose PH, but SH can be tricky for generalists to disentangle from NGI; nevertheless, primary care physicians have important roles in this area. […] As the diagnosis of hypogonadism is not always straightforward, careful clinical and biochemical assessment is essential prior to prescribing.

• #2 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-hypogonadism

  The aim of pharmacological management of hypogonadism is to increase testosterone levels to normal levels which resolve or improve symptoms of hypogonadism. The first choice is to administer exogenous testosterone. However, while exogenous testosterone has a beneficial effect on the clinical symptoms of hypogonadism, it inhibits gonadotropin secretion by the pituitary gland, resulting in impaired spermatogenesis and sperm cell maturation. […] Testosterone therapy is contraindicated in hypogonadal men seeking fertility treatment.

• #2 Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1472884/

  There are few absolute contraindications to testosterone replacement therapy other than prostate or breast cancer, a hematocrit of 55% or greater, or sensitivity to the testosterone formulation. […] Hypogonadism can be easily diagnosed with measurement of the early morning serum total testosterone level, which should be repeated if the value is low.

• #2 Testosterone Therapy for Hypogonadism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy

  Recommends making a diagnosis of hypogonadism only in men with symptoms and signs consistent with testosterone (T) deficiency and unequivocally and consistently low serum T concentrations. […] Recommends the use of accurate assays for the measurement of total and free testosterone and rigorously derived reference ranges for the interpretation of testosterone levels. […] Recommend confirming the diagnosis by repeating the measurement of morning fasting total T concentrations. […] In men determined to have androgen deficiency, we recommend additional diagnostic evaluation to ascertain the cause of androgen deficiency. […] We recommend against starting T therapy in patients who are planning fertility in the near term or have any of a number of specified conditions. […] We recommend diagnosing hypogonadism in men with symptoms and signs of testosterone deficiency and unequivocally and consistently low serum total testosterone and/or free testosterone concentrations (when indicated).

• #2 Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/

  In addition to laboratory tests and a careful physical examination, a brief screening instrument has also been developed to aid in the diagnosis of hypogonadism. […] Once testosterone deficiency is confirmed, we then consider testosterone replacement therapy. […] The goal of testosterone replacement therapy is to provide and maintain a normal level of testosterone, thereby restoring libido and improving erectile function; improving mood and providing a sense of well-being; decreasing fatigue; and improving lean body mass, strength and stamina. […] Several treatment options exist for testosterone replacement, including oral preparations of testosterone derivatives; intramuscular injections of long-acting testosterone esters; transdermal patches applied to the scrotum or other areas of the body; and a recently approved 1% testosterone gel.

• #3 Hypogonadism in men – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/1093

  Hypogonadism in men may present with reproductive/sexual clinical features (e.g., incomplete pubertal development, infertility, gynaecomastia), as well as non-reproductive features (e.g., fatigue, osteoporosis, loss of motivation or concentration, irritability, low or labile mood, body image concerns). […] Early morning fasting serum total testosterone level below 10.4 nanomol/L (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 gonadotrophins (luteinising hormone [LH], follicle stimulating hormone [FSH]) distinguishes between a primary cause (dysfunction of the testes) and a secondary (also known as central or hypogonadotrophic) cause (pituitary or hypothalamic dysfunction).

• #3 Hypogonadism Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/922038-workup

  Careful history taking, including of family and medication history, along with a physical examination, can guide the differential diagnosis and appropriate workup in hypogonadism. In postpubertal males, measurement of morning serum testosterone concentrations can establish the diagnosis of hypogonadism. […] LH and FSH can be used to distinguish between hypogonadotropic and hypergonadotropic hypogonadism and guide further evaluation and management in both males and females. Hypergonadotropic hypogonadism indicates a primary gonadal defect (congenital or acquired), while hypogonadotropic hypogonadism suggests a hypothalamic/pituitary process (congenital or acquired). […] For males after puberty, the guidelines of the Endocrine Society require that the diagnosis of hypogonadism be based on symptoms and signs of hypogonadism plus the presence of a low testosterone level measured on at least two occasions. Because of the diurnal variation in testosterone levels, a morning sample is recommended.

• #3 Appropriate testosterone testing for male hypogonadism | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/testosterone-testing-male-hypogonadism/

  The therapeutic use of testosterone has increased dramatically in the last two decades. […] For these reasons, it is particularly important to have a rational approach to testing and diagnosis of hypogonadism in men. […] The clinical diagnosis of hypogonadism is made in men who have low total testosterone levels combined with symptoms and/or signs suggesting hypogonadism. […] Total testosterone (TT) is the most direct measure of testosterone in men. […] If TT is unequivocally normal or low, no further testing is needed. […] Testosterone level should be repeated at least twice (or 3 times in the case of equivocal results) over weeks or months, to confirm a consistently low value in the absence of any other external cause. […] If an unequivocally low testosterone is identified, luteinizing hormone (LH) and follicular stimulating hormone (FSH) should be ordered (along with a repeat morning testosterone).

• #3 Hypogonadism | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/hypogonadism

  To diagnose hypogonadism, tests may be performed to check hormone levels estogren in females and testosterone in males. […] In addition, levels of luteinizing hormone (LH) and follicle stimulating hormones (FSH) will be tested. LH and FSH are pituitary hormones that are stimulated by the gonads. […] Other tests may measure thyroid hormones, sperm count and prolactin, a hormone released by the pituitary gland that stimulates breast development and milk production Tests also may be performed to test for anemia and possible genetic causes of symptoms. […] If pituitary disease is suspected, a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan may be performed to examine the the pituitary gland.

• #3 Testosterone Deficiency Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

  6. In patients with low testosterone, clinicians should measure serum luteinizing hormone levels. […] 7. Serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/normal luteinizing hormone levels. […] 8. Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders. […] 9. Clinicians should inform testosterone deficient patients that low testosterone is a risk factor for cardiovascular disease. […] 10. Patients should be informed that testosterone therapy may result in improvements in erectile function, low sex drive, anemia, bone mineral density, lean body mass, and/or depressive symptoms. […] 11. Patients should be informed that the evidence is inconclusive whether testosterone therapy improves cognitive function, measures of diabetes, energy, fatigue, lipid profiles, and quality of life measures.

• #3 Testosterone Therapy: Review of Clinical Applications | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p441.html

  Although there is no universal laboratory definition of hypogonadism, in most laboratory reference ranges, the lower limit of normal is between 250 and 350 ng per dL (8.7 to 12.2 nmol per L). […] If low testosterone is confirmed, luteinizing hormone and follicle-stimulating hormone levels should be measured to categorize the deficiency as primary or secondary. […] Testosterone measurement should be considered in older men with unexplained anemia. […] Men receiving testosterone therapy should be monitored regularly for adverse effects and treatment effectiveness, including testosterone measurements, complete blood count to measure hematocrit, and prostate-specific antigen testing. […] Most experts agree that the goal serum testosterone level should be in the midnormal range (i.e., 400 to 700 ng per dL [13.9 to 24.3 nmol per L]); values outside of this range require a dose adjustment.

• #3 Testosterone deficiency: diagnosis, assessment and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/testosterone-deficiency-diagnosis-assessment-and-treatment

  In the presence of symptoms, a TT level of <8 nanomol/L or a FT level of <180 picomol/L requires treatment. [...] Prior to starting TRT, patients should be assessed to rule out the contraindications listed in Box 3. [...] TD is associated with male infertility and can be diagnosed during investigations performed for infertility. In such patients, or in those who have a desire to have children, TRT should not be offered as first-line treatment. [...] If a significant and continuous rise in PSA is seen, notably above the age-specific range, a digital rectal examination should be carried out and the patient should be referred to a urologist for further investigations for prostate cancer. [...] TD can affect male psychological, sexual and physical health. Making a correct diagnosis can alleviate this and lead to an improvement in quality of life.

• #3 Testosterone deficiency: Practical guidelines for diagnosis and treatment | British Columbia Medical Journal

  https://bcmj.org/articles/testosterone-deficiency-practical-guidelines-diagnosis-and-treatment

  Testosterone deficiency in men is a common but often-missed diagnosis. […] After confirmation of the diagnosis, exclusion of any reversible causes, or contraindications to the use of testosterone, replacement therapy may be offered. […] Confirming a diagnosis of hypogonadism generally involves three components. First, there should be symptoms of androgen deficiency; second, there should be unequivocal biochemical evidence of low testosterone levels; and third, there should be a positive response to testosterone replacement therapy. If all three of these diagnostic components are not present, the practitioner should question the diagnosis and consider discontinuing testosterone therapy. […] To confirm a diagnosis of hypogonadism physicians should look for: Symptoms of androgen deficiency. Unequivocal biochemical evidence of low testosterone levels. A positive response to testosterone replacement therapy.

• #3 Testosterone deficiency: diagnosis, assessment and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/testosterone-deficiency-diagnosis-assessment-and-treatment

  Symptoms of TD can be classified as sexual, cognitive or physical. Sexual symptoms (low libido, erectile dysfunction and decreased early morning and nocturnal erections) are most often associated with TD. […] When results are borderline and close to 12 nanomol/L, FT should also be checked. This is an assessment of the bioavailable testosterone and can be measured provided SHBG and albumin levels are available. […] For all patients with low testosterone levels (<12 nanomol/L), LH levels should be assessed to help differentiate between primary or secondary TD. [...] The aim of testosterone treatment is to restore physiological androgen dependent functions and to improve the patient’s quality of life (e.g. sexual function, muscle strength and bone mineral density). [...] Patients who have both a low serum testosterone level and show symptoms of TD should be offered treatment. For symptomatic patients, making the correct diagnosis and initiating treatment to reach normal levels of serum testosterone can significantly improve quality of life.

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