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Male Hypogonadism


Presentation

  • Compounds such as dihydrotestosterone, human chorionic gonadotropin, aromatase inhibitors and clomiphene are presently being studied in specific subgroups of men.[ncbi.nlm.nih.gov]
Fatigue
  • Symptoms associated with hypogonadism include reduced sex drive, fatigue, and mood disturbances, but accurate diagnosis requires biochemical testing.[ncbi.nlm.nih.gov]
Anemia
  • 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]
  • Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells.[digitalnaturopath.com]
Limited Mobility
  • We recommend against using TS to improve cardiac outcome and limited mobility. We recommend against using TS in men with prostate cancer, unstable cardiovascular conditions or elevated haematocrit.[ncbi.nlm.nih.gov]
Beak Nose
  • These patients have similar features to MAD patients such as hypoplastic mandible, beaked nose, stiff joints, and sclerodermatous skin.[ncbi.nlm.nih.gov]
Beaked Nose
  • These patients have similar features to MAD patients such as hypoplastic mandible, beaked nose, stiff joints, and sclerodermatous skin.[ncbi.nlm.nih.gov]
Headache
  • Adverse effects associated with therapy include headache, hot flushes, insomnia, increased blood pressure, acne, emotional labiality, and nervousness.[ncbi.nlm.nih.gov]
  • 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]
  • […] pituitary macroadenoma or other mass in men with any of the following: Age 60 yr with no other identified cause for hypogonadism Very low total testosterone levels ( 200 ng/dL) Elevated prolactin levels Symptoms consistent with a pituitary tumor (eg, headache[merckmanuals.com]
  • In addition to this, intracranial pressure resulting from the tumor will possibly bring about headaches which may range from minor, yet persistent, all the way to major migraines.[hgh.tv]
  • MRI pituitary scanning is particularly important for men with headaches, visual field abnormalities, a high serum PRL, very low serum testosterone, low or normal serum LH, or if other pituitary hormone deficiencies are present.[fitzgeraldmd.com]
Sexual Dysfunction
  • 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]
  • Later in life, this may result in reduced male fertility, sexual dysfunction, decreased muscle formation and bone mineralisation, disturbances of fat metabolism and cognitive dysfunction and may contribute to the development of testicular tumours.[uroweb.org]
  • Are Erectile Dysfunction and Other Sexual Dysfunctions Common in Opioid Treatment? Erectile dysfunction in male and infertility in female is less common when short acting opioids are taken for short period of time.[epainassist.com]
Hot Flushes
  • 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]
  • Less common adverse effects include gynaecomastia, male pattern balding (which can be familial) and weight gain, as well as fluctuations in mood, libido or hot flushes, which reflect stop–start treatment or excessive fluctuations in serum testosterone[mja.com.au]
  • Symptoms of hypogonadism can include mood changes, reduced libido, low energy, decreased muscle bulk and strength, hot flushes, decreased ability to concentrate, lack of morning erections, decreased volume of ejaculate, and infertility.[bcmj.org]
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]
  • Talking about hypogonadism means not only the classical types of hypogonadism: due to classical testicular disease of central, hypothalamic and hypophysis disease, but also the partial testosterone deficiency induces by aging (late onset hypogonadism)[intechopen.com]
  • Sperm are manufactured in cells known as seminiferous tubules, and these cells are more sensitive to the damage that results from most testicular diseases.[hgh.tv]

Workup

  • […] 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]
  • […] should be managed as per recommendations; if there are no identifiable causes, initiation of TRT should be considered. 5,10,20,21 A subtle but notable difference between guidelines is the variation of other lab screenings suggested in the diagnostic workup[journals.lww.com]
  • Even those at-risk patients who report no symptoms typical of hypogonadism require a thorough clinical and biochemical workup for TD National and international guidelines concur in recommending TD screening for men deemed at risk due to coexisting illnesses[slideshare.net]
Delayed Bone Age
  • Delayed bone age (when maturity of the skeleton is behind for your age in years).[yourhormones.info]
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]
Testosterone Decreased
  • As testosterone decreases, some men may experience symptoms similar to those of menopause in women.[fortishealthcare.com]

Treatment

  • 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]

Prognosis

  • 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]

Etiology

  • […] 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]
  • In conclusion, assessment of serum AMH is helpful to evaluate gonadal function, without the need for stimulation tests, and guides etiological diagnosis of pediatric male hypogonadism.[ncbi.nlm.nih.gov]
  • FSH 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]

Epidemiology

  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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

  • 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]
  • 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]

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