Compounds such as dihydrotestosterone, human chorionic gonadotropin, aromatase inhibitors and clomiphene are presently being studied in specific subgroups of men. [ncbi.nlm.nih.gov]

Secondary hypogonadism  Hypothalamic/pituitary cause (often presents as delayed puberty or infertility)  Genetic, structural or environmental causes Possible aetiologies 18. [slideshare.net]

It must be emphasised that clinical guidelines present the best evidence available to the experts. However following guideline recommendations will not necessarily result in the best outcome. [uroweb.org]

• Fatigue

  Symptoms associated with hypogonadism include reduced sex drive, fatigue, and mood disturbances, but accurate diagnosis requires biochemical testing. [ncbi.nlm.nih.gov]

  […] hypogonadism Prepubertal Delayed development of secondary sexual characteristics Small testes, genitalia Decrease in height Postpubertal Sexual difficulties Erectile dysfunction Infertility Decreased muscle and/or skeletal mass Decreased body hair Low energy, fatigue [arupconsult.com]

• Anemia

  Signs of hypogonadism include (1) anemia; (2) muscle wasting (sarcopenia); (3) reduced bone mass or bone mineral density (BMD); (4) absence or regression of secondary sex characteristics; (5) abdominal adiposity (i.e. [medscape.com]

  The clinical features associated with true male hypogonadism are nonspecific and include impaired libido, erections, and fertility; reductions in lean muscle mass and bone density; loss of facial, axillary, and pubic hair; anemia; and changes in mood [jamanetwork.com]

  Apart from reduced levels of testosterone, clinical hallmarks of hypogonadism include absence or regression of secondary sex characteristics, reduced fertility (oligospermia, azoospermia), anemia, muscle wasting, reduced bone mass (and bone mineral density [ncbi.nlm.nih.gov]

  Third, many men with hypopituitarism have mild anemia due to testosterone deficiency. Other hormone deficiencies may contribute to the anemia. [pituitaryworldnews.com]

  […] dysfunction Decreased sense of well-being Depressed mood Difficulties with concentration and memory Fatigue Moodiness and irritability Loss of muscular strength Other changes that occur with low testosterone include: A decrease in hemoglobin and mild anemia [my.clevelandclinic.org]

• Anorexia

  […] that may be associated with hypogonadism include type II diabetes mellitus (DM); cancer; acquired immune deficiency syndrome; cirrhosis of the liver; renal failure; hyperthyroidism or hypothyroidism; Cushing syndrome; protein-calorie malnutrition (and anorexia [medscape.com]

  Although most patients who deal with anorexia are female, the effects of anorexia on the endocrine system of both males and females is very significant and in some cases can persist for a long period of time after anorexia is officially diagnosed and [hgh.tv]

  […] lesions (eg, tumours and cysts) Infiltrative disease (eg, sarcoidosis and haemochromatosis) Infection (eg, meningitis) Pituitary apoplexy (bleeding into pituitary gland) Trauma Suppression of gonadotropins as a result of: Chronic disease (eg, diabetes, anorexia [dermnetnz.org]

  Causes of central hypogonadism include: Anorexia nervosa Bleeding in the area of the pituitary Taking medicines, such as glucocorticoids and opiates Stopping anabolic steriods Genetic problems Infections Nutritional deficiencies Iron excess ( hemochromatosis [medlineplus.gov]

  People with anorexia nervosa (excessive dieting to the point of starvation) also may have central hypogonadism. [encyclopedia.com]

• Asymptomatic

  Abstract Osteoporosis is an asymptomatic, systemic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue, resulting in increased bone fragility. [ncbi.nlm.nih.gov]

  It is also important to note that many men with low blood levels of testosterone are completely asymptomatic and appear completely healthy. [urology.ucsf.edu]

  ESR, 10 mm/h; B27 (-) Normal None 47,XXY(68%)/46,XY(32%) 7 21 Gonadal dysgenesis with Asymptomatic ESR, 15 mm/h; B27 (-) Normal None mosaicism; 45,X/47,XYY 8 17 Bilateral cryptorchidism, Asymptomatic ESR, 15 mm/h; B27 (-) Normal None orchidectomy; 46 [arthritis-research.biomedcentral.com]

  Testicular function in asymptomatic chronic alcoholics: relation to ethanol intake. Alcoholism, Clinical and Experimental Research. 1997; 21:128–33. [link.springer.com]

• Pathologist

  Clinical assessment of androgen status relevant to clinical biochemists and chemical pathologists is outlined in this review. [ncbi.nlm.nih.gov]

• Sweating

  […] depressed mood decreased libido lethargy sleep disturbances decreased muscle mass and strength loss of body hair (pubic, axillary, facial) osteoporosis and decreased bone mineral density increased body fat breast discomfort and enlargement hot flashes sweating [medicalnewstoday.com]

• Increased Sweating

  […] body fat growth of breast tissue (gynaecomastia) thinning of the bones (osteoporosis) reduced muscle bulk and physical strength a wrinkled ‘parchment-like’ appearance of the skin increased sweating. [yourhormones.info]

• Decreased Muscle Mass

  Hypogonadism in Adult Men When hypogonadism occurs in grown men, it can impair normal reproductive function and can cause erectile dysfunction, infertility, decreased beard and body hair growth, decreased muscle mass, development of breast tissue, and [rejuvchip.com]

  The symptoms during pre-puberty include impaired growth of external male genitals, improper distribution of body hair, decreased muscle mass, gynecomastia or development of breast tissues, lack of deepening of the voice and disproportional growth of arms [uhs.ae]

  Finally, infertility, erectile dysfunction, decreased muscle mass and body hair, smaller testicles, gynecomastia, osteoporosis, mood changes, and decreased cognitive skills in adult men. [study.com]

• Arthritis

  PubMed Google Scholar Cutolo M, Balleari E, Giusti M, Intra E, Accardo S: Androgen replacement therapy in male patients with rheumatoid arthritis. Arthritis Rheum. 1991, 34: 1-5. [arthritis-research.biomedcentral.com]

  […] corticosteroids, opiates) Hyperprolactinemia Pituitary lesions Iron overload Hemochromatosis Thalassemias Sickle cell disease Hepatic defects Alcohol abuse Exogenous estrogen Severe chronic illness Cancer Chronic liver disease Chronic renal disease Rheumatoid arthritis [arupconsult.com]

• Headache

  In men the symptoms are: Breast enlargement Muscle loss Decreased interest in sex (low libido) If a pituitary or other brain tumor is present (central hypogonadism), there may be: Headaches or vision loss Milky breast discharge (from a prolactinoma) Symptoms [medlineplus.gov]

  Adverse effects associated with therapy include headache, hot flushes, insomnia, increased blood pressure, acne, emotional labiality, and nervousness. [ncbi.nlm.nih.gov]

• Hyperactivity

  "Risperidone for attention-deficit hyperactivity disorder in people with intellectual disabilities". Cochrane Database Syst Rev (2): CD007011. PMID 19370667. [hi.wikipedia.org]

• Sexual Dysfunction

  Symptoms of postpubertal hypogonadism include[1,2,3] (1) sexual dysfunction, such as reduced libido, erectile dysfunction (ED), diminished penile sensation, difficulty attaining orgasm, as well as reduced ejaculate with orgasm; (2) reduced energy, vitality [medscape.com]

  Low testosterone levels in these patients can be associated with loss of lean body mass and bone mass density, decline in mood, loss of energy, and sexual dysfunction. [ncbi.nlm.nih.gov]

  A detailed sexual history should also be performed preferably with the partner present. Psychochological and marital factors which contribute to sexual dysfunction can be ascertained. [link.springer.com]

• Hot Flushes

  flushes in some cases of acute onset. [medscape.com]

  Some patients, particularly those with partial androgen deficiency of the aging male, also experience sexual dysfunction, reduced sense of vitality, depressed mood, increased irritability, difficulty concentrating, and/or hot flushes in certain cases [ncbi.nlm.nih.gov]

  Sometimes affected individuals may experience emotional and mental disturbances, fatigue, loss of libido, hot flushes and lack of concentration. [uhs.ae]

  Vasomotor and nervous – Hot flushes – Sweating Androgen Deficiency Symptoms cont’d 12. – Diminished muscle mass – Loss of body hair – Abdominal obesity – Gynecomastia – Testes frequently normal, occasionally small Physical Signs Androgen Deficiency Symptoms [slideshare.net]

• Testicular Disease

  Hypogonadism may arise from testicular disease (primary hypogonadism) or dysfunction of the hypothalamic-pituitary unit (secondary hypogonadism). [ncbi.nlm.nih.gov]

  Classified as primary (resulting from testicular disease), secondary (resulting from pituitary and/or hypothalamic disease), or combined primary/secondary. -- To view the remaining sections of this topic, please sign in or purchase a subscription -- Last [hopkinsguides.com]

  disease.2-4 Controversy has arisen over the role of testosterone treatment in older men with medical comorbidities who have low levels of circulating testosterone, in the absence of hypothalamic, pituitary or testicular disease.5 There are gaps in the [mja.com.au]

  disease [ 79 ]) or testicular tumors with testosterone deficiency after treatment [ 80 ]. [intechopen.com]

• Amenorrhea

  As in women with functional amenorrhea, the degree of suppression of reproductive function serves as a barometer of illness severity. [endocrinenews.endocrine.org]

  Manifestations include eunuchism, eunuchoidism, Frohlich's syndrome, amenorrhea, and incomplete development or maintenance of secondary sex characteristics. hypogonadism decreased functional activity of the gonads, with reduced production of germ cells [medical-dictionary.thefreedictionary.com]

  […] age, poorly developed secondary sexual characteristics, or infertility. [5] In men with CHH, serum levels of inhibin B are typically very low as inhibin B is a marker of Sertoli cell number. [3] For females, CHH is most commonly revealed by primary amenorrhea [en.wikipedia.org]

  One presented with primary amenorrhea and infertility,9 and the other with delayed puberty.10 In this report, we describe a man with impaired secretion of follicle-stimulating hormone caused by a homozygous mutation in the gene for the β-subunit of follicle-stimulating [nejm.org]

Available online at https://emedicine.medscape.com/article/922038-workup#c6. Accessed March 2018. (Updated 2018 March). Male Hypogonadism. ARUP Laboratories. Available online at https://arupconsult.com/content/hypogonadism-male. Accessed March 2018. [labtestsonline.it]

[…] growth and maturation Testicular tissue testing: If the testes are not palpable and if it is not certain whether any testicular tissue is present, administering human chorionic gonadotropin (hCG) and measuring testosterone response may be helpful See Workup [emedicine.medscape.com]

This is also true in patients with an elevated prostate-specific antigen (PSA) >3 ng/mL, without further urologic workup.7 Goals of Therapy Goals of treating hypogonadal patients are focused around improvement of those symptoms, many of which can be achieved [uspharmacist.com]

[…] in testosterone that occurs in the afternoon.[ 4-6 ] Screening for hypogonadism in the general population is not indicated.[ 4 ] Case finding in selected circumstances is, however, acceptable, such as when testing for low testosterone is part of the workup [bcmj.org]

• Delayed Bone Age

  Delayed bone age (when maturity of the skeleton is behind for your age in years). [yourhormones.info]

• Testosterone Decreased

  As men age, there's a slow, progressive decrease in testosterone production. The rate varies greatly. [mayoclinic.org]

  As testosterone decreases, some men may experience symptoms similar to those of menopause in women. [fortishealthcare.com]

• Sperm Count Decreased

  Symptoms include low sperm count, decreased libido, erectile dysfunction, fatigue, sleep disturbances and depression. In primary hypogonadism, the testes fail to make testosterone because of infection or injury to the testes. [froedtert.com]

The few treatments that are FDA-approved such as testosterone topicals, injections, and pellets create significant demand from patients for treatments with more convenient means of administration, fewer adverse effects, and the ability to maintain male [ncbi.nlm.nih.gov]

Despite conflicting observational studies and relatively small randomized treatment trials, concerns regarding the possible cardiovascular safety of testosterone treatment led to new Food and Drug Administration (FDA) labeling for testosterone formulations [endocrinenews.endocrine.org]

Prognosis Many forms of hypogonadism are potentially treatable and have a good prognosis. Prevention People should maintain normal body weight and have healthy eating habits to prevent anorexia nervosa. Other causes may not be preventable. [encyclopedia.com]

Outlook / Prognosis What can I expect if I have low testosterone (male hypogonadism)? There’s no one-time fix for low testosterone. [my.clevelandclinic.org]

[…] testosterone – secondary or tertiary hypogonadism Prolactin Consider prolactin measurement in secondary hypogonadism Elevated prolactin should prompt evaluation of pituitary gland Associated testing – Endocrine Society recommends investigating causes/etiology [arupconsult.com]

Abstract and Etiology Abstract Male hypogonadism has a multifactorial etiology that includes genetic conditions, anatomic abnormalities, infection, tumor, and injury. [medscape.com]

[…] levels are variable based on presence of inhibin ↑ FSH if seminiferous tubule dysfunction is also present inhibin normally released by Sertoli cells to inhibit FSH if damaged that feedback is lost normal FSH if dysfunction is limited to Leydig cells etiologies [step1.medbullets.com]

Abstract Male hypogonadism has a multifactorial etiology that includes genetic conditions, anatomic abnormalities, infection, tumor, and injury. [ncbi.nlm.nih.gov]

There is no clear epidemiological data to indicate whether male hypogonadism is independently associated with clinical and biological sequelae of cancer cachexia, such as higher inflammation, fatigue, and body wasting. [ncbi.nlm.nih.gov]

Links: epidemiology aetiology hypothalamic - pituitary - gonadal (HPG) axis in testosterone deficiency (TD) clinical features screening and assessment for testosterone defiency (TD) investigation in testosterone deficiency treatment testosterone androgen [gpnotebook.co.uk]

4.0 is a contraindication to testosterone replacement (Bhasin, Endocrine Society, 2018) CBC – evaluate for increased red cell mass Hematocrit >55% is a contraindication to testosterone replacement Check at 3, 6, and 12 months, then annually Background Epidemiology [arupconsult.com]

This review discusses how to approach the finding of a low testosterone value, stressing the need to confirm the finding, the underlying pathophysiologic processes, drugs that can be responsible, and the importance of determining whether the cause is [ncbi.nlm.nih.gov]

Comprehensive and highly practical, Male Hypogonadism: Basic, Clinical, and Therapeutic Principles lucidly interprets a large body of scientific information on male reproductive endocrinology to provide a thorough understanding of the pathophysiology, [amazon.com]

Prevention of Hypogonadism In many cases, such as with tumors, there is no way to prevent Hypogonadism. It can only be treated as symptoms arise. [hgh.tv]

The W28X mutation produces a truncated LHB peptide of seven amino acids, which prevents the synthesis of intact LH. After 40 days of treatment with hCG, the patient exhibited a few spermatozoa in the semen. [ncbi.nlm.nih.gov]

Surgical repair helps prevent future complications. For secondary hypogonadism, doctors treat any underlying disorder of the pituitary gland or hypothalamus. [msdmanuals.com]