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]

• Male Hypogonadism

  The overall prevalence of male hypogonadism based upon low serum total testosterone levels is high and increases with age. There are many pitfalls in making the diagnosis of male hypogonadism. [ncbi.nlm.nih.gov]

  What causes male hypogonadism? Male hypogonadism can be divided into two groups. [yourhormones.info]

• Infertility

  LHR mutations may represent an underestimated cause of infertility in women, in addition to being responsible for male hypogonadism with reduced spermatogenesis. [ncbi.nlm.nih.gov]

  Letrozole has also been evaluated in the setting of male infertility. Saylam and associates 39 treated 27 infertile patients with a T/E ratio of < 10 with letrozole. [read.nxtbook.com]

  Does Opioid Cause Erectile Dysfunction And Infertility? Yes, long-term opioid treatment can cause erectile dysfunction (ED) and infertility. Opioids are regularly used by 4.3 million Americans for treatment of chronic cancer and non-cancer pain. [epainassist.com]

• 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]

• Pain

  Opioids are regularly used by 4.3 million Americans for treatment of chronic cancer and non-cancer pain. How Long Non-Cancer Pain Can Last? Non-cancer chronic pain may last for several years. Opioid causes hypogonadism in male and female patients. [epainassist.com]

  The most common ADRs were increase in hematocrit, increase in PSA, and injection site pain (all CONCLUSION: In this largest worldwide sample of hypogonadal men, injectable long-acting TU was effective and well tolerated. © 2012 International Society for [ncbi.nlm.nih.gov]

• 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]

• Deepening of Voice

  Other Male Characteristics: stimulation of erythropoiesis (increase hematocrit); acts on larynx (deepening of voice); increase libido; enlargement of penis; bone maturation; increase in height, muscle mass, & body hair (pubic, chest, facial) What are [quizlet.com]

  In men, the pubertal effects include enlargement of the sebaceous glands, penis enlargement, increased libido, increased frequency of erections, increased muscle mass, deepening of voice, increased height, bone maturations, loss of scalp hair, and growth [ncbi.nlm.nih.gov]

• Vomiting

  […] nausea and vomiting (PONV) Scientific Title Effect of immediate postoperative refeeding with oral carbohydrate-rich solution on nausea and vomiting after elective orthopedic surgery under general anesthesia Scientific Title:Acronym Effect of postoperative [upload.umin.ac.jp]

  Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; [digitalnaturopath.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]

• Hirsutism

  Hirsutism, polycystic ovarian disease, and ovarian 17-ketosteroid reductase deficiency. N Engl J Med 1987 ;316: 1295 - 1301 5. Toscano V, Balducci R, Bianchi P, Mangiantini A, Sciarra F. [nejm.org]

• 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]

• Loss of Libido

  Clinical presentations were small genitalia (65%), absent secondary sexual characteristics (53%), not attained puberty (47%), infertility (53%), erectile dysfunction (41%) and loss of libido (29%). [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]

  For example, erectile dysfunction, loss of libido and mood swings may be the result of either: stress depression anxiety There are also physical causes of erectile dysfunction, such as changes in the blood vessels, which may happen alongside any psychological [nhs.uk]

  Signs and Symptoms of Hypogonadism Low testosterone, or male hypogonadism, is associated with a number of signs and symptoms, most notably loss of libido and erectile dysfunction (ED). [bumc.bu.edu]

  Recent results from both the European Male Aging Study (EMAS) and The Testosterone Trials suggested that sexual symptoms, in particular loss of libido, are important symptoms of androgen deficiency, so that their absence should lead one to question (but [endocrinenews.endocrine.org]

• 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]

• Stroke

  All men should be checked for heart disease and stroke before, and periodically while on, TT. [urologyhealth.org]

  "Testosterone Products: Drug Safety Communication - FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke". FDA. [en.wikipedia.org]

  FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. March 3, 2015. [reliasmedia.com]

• 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]

• Kidney Failure

  failure HIV/AIDS Inflammatory conditions such as sarcoidosis (a condition that causes inflammation of the lungs and other organs) Kallman syndrome (abnormal development of the hypothalamus, a gland in the brain that controls many hormones) Klinefelter [my.clevelandclinic.org]

  Testicular failure can be caused by viral infection (e.g., mumps), irradiation, cancer chemotherapy, radioisotope therapy, autoimmunity, kidney failure, and male menopause. [fitzgeraldmd.com]

• Renal Insufficiency

  Several acute disorders and chronic systemic disorders (eg, chronic renal insufficiency, anorexia nervosa) may lead to hypogonadotropic hypogonadism, which resolves after recovery from the underlying disorder. [merckmanuals.com]

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]