Hypogonadism in Men: Approaches and Treatment

The diagnosis of hypogonadism should be made only in men with symptoms and signs of testosterone deficiency and unequivocally and consistently low serum testostrone concentrations. Male hypogonadism may be hypergonadotropic or hypogonadotropic (central). Treatment of central hypogonadism depends on the treatment of its etiology, for example prolactinoma. If hypogonadism does not resolve, testostrone replacement therapy will be planned. In hypergonadotropic hypogonadism, karyotype analysis has be done to ruled out Klinfelter to manage the co-existing abnormalities.Testostrone therapy is indicated for men with symptomatic testostrone deficiency to induce and maintain secondary sex characteristics and correct symptoms of hypogonadism after discussing the potential benefits and risks of therapy and monitoring the treatment. Endocrine Society recommended that testosterone therapy not be started in patients who are planning fertility in the near term or have any of the following conditions:breast or prostate cancer, a palpable prostate nodule or induration, prostate-specific antigen level 4 ng/mL, prostate-specific antigen 3 ng/mL in men at increased risk of prostate cancer (e.g., men with a first-degree relative with diagnosed prostate cancer) without further urological evaluation, elevated hematocrit (> 54%), untreated severe obstructive sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, myocardial infarction or stroke within the last 6 months, or thrombophilia. Aim of testosterone therapy, is to keep testosterone concentrations in the mid-normal range during treatment with any of the approved formulations, by considering patient preference, formulation-specific adverse effects, treatment burden, and cost. The patients should be monitored by evaluating symptoms, testosterone adverse effects, and compliance; measuring serum testosterone and hematocrit concentrations; and evaluating prostate cancer risk during testosterone therapy.