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Primary Male Hypogonadism


Presentation

  • الصفحة 69 - Men homozygous for an inactivating mutation of the follicle-stimulating hormone (FSH) receptor gene present variable suppression of spermatogenesis and fertility. Nat Genet 1997; 15:205-206. ‏ الصفحة 97 - Harman SM, Tsitouras PD.[books.google.com]
  • […] cryptorchid, testosterone production is normal because Leydig cells are not affected by temperature loss of negative feedback of testosterone results in LH FSH levels are variable based on presence of inhibin FSH if seminiferous tubule dysfunction is also present[medbullets.com]
  • Symptoms and Signs Clinical presentation depends on whether, when, and how testosterone and sperm production are affected. (For presentation in adulthood, see Male Hypogonadism : Symptoms and Signs .)[merckmanuals.com]
  • The testes are small and osteoporosis may be present. The diagnosis is suspected clinically and is confirmed with decreased circulating testosterone concentrations.[colombiamedica.univalle.edu.co]
Male Hypogonadism
  • Background: Development of the new methods of treatment of primary male hypogonadism is an urgent medical problem. Its solution requires a suitable experimental model of the disease.[ingentaconnect.com]
  • NPs must select and follow the best guideline recommendations available to optimally treat male hypogonadism.[nursingcenter.com]
  • This article discusses parameters for screening patients at risk, reviews how to establish the diagnosis of primary or secondary male hypogonadism, and offers important considerations for treatment of patients with hypogonadism.[journals.lww.com]
  • Larson, Approaches to male hypogonadism in primary care, The Nurse Practitioner, 42, 2, (32), (2017). John E. Morley, Angela M.[doi.org]
  • Overview: Male Hypogonadism 14. Primary Male Hypogonadism 15. Primary Male Hypogonadism: Klinefelter's Syndrome 16. Primary Male Hypogonadism: Testicular Trauma and Anorchia 17. Primary Male Hypogonadism: Infectious Agents 18.[sciencemedia.com]
Fatigue
  • Symptoms include low testosterone, low energy, fatigue, and a lower sexual drive.[my.clevelandclinic.org]
  • This is largely because the symptoms of hypogonadism are nearly identical to those experienced by men going through andropause (the male menopause): low libido, fatigue, depression, memory loss, difficulty concentrating, and irritability.[bodylogicmd.com]
  • Typical symptoms include a low sex drive, erectile dysfunction, infertility, fatigue, weight gain and enlarged breasts. Over time, hypogonadism can lead to bone loss, which increases the risk of fractures.[nyhq.org]
  • […] 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]
  • These may include: Fatigue Decreased sex drive Difficulty concentrating Hot flashes When to see a doctor See a doctor if you have any symptoms of male hypogonadism.[mayoclinic.org]
Anemia
  • 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[ucsfhealth.org]
  • You may need to have tests to check: Estrogen level (women) Follicle stimulating hormone ( FSH level ) and luteinizing hormone ( LH) level Testosterone level (men) Other measures of pituitary function Other tests may include: Blood tests for anemia and[medlineplus.gov]
  • By contrast, testosterone depletion is associated with: Loss of lean muscle mass Anemia Osteoporosis Insulin resistance Increased lipids (fat and/or cholesterol) in the blood Increased subcutaneous fat in the abdomen Testosterone Deficiency Testosterone[verywell.com]
  • Nonspecific signs and symptoms include depressed mood, sleep disturbance, mild anemia, sleepiness after a meal, reduced muscle mass, and increased body fat.[ahcmedia.com]
  • […] 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 for osteoporosis or unexplained anemia[bcmj.org]
Unable to Bend
  • These were poor morning erection, diminished sexual thoughts, erectile dysfunction, unable to do vigorous activity, limited in walking more than 1 km, and unable to bend (details in Supplemental Appendix published as supplemental data on The Endocrine[academic.oup.com]
Ulcer
  • […] value for ANOVA for age, analysis of covariance test (age adjusted) for continuous variables and χ 2 for categorical variables. b Self-reported health conditions including heart condition, high blood pressure, cancer ever, bronchitis, asthma, peptic ulcer[academic.oup.com]
Sexual Dysfunction
  • Dana Stoian, Ioana Mozos, Marius Craina, Corina Paul, Iulian Velea, Adalbert Schiller and Mihaela Craciunescu, Hypogonadism in Male Sexual Dysfunction, Sexual Dysfunction, 10.5772/intechopen.69107, (2017).[doi.org]
  • Depending on when it begins, hypogonadism may affect the development of sex organs, interfere with puberty or cause infertility and sexual dysfunction. Children with hypogonadism do not progress through puberty.[chop.edu]
  • dysfunction is relatively low — about 2% in the European Male Aging Study. 35 However, while that study interpreted declining serum testosterone levels as causing sexual dysfunction, there is evidence that sexual activity modestly increases serum testosterone[mja.com.au]
  • If it occurs after puberty, there may be infertility and sexual dysfunction. In adult men, symptoms begin within a few weeks of the onset of testosterone deficiency.[medicalnewstoday.com]
Testicular Disease
  • 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[mja.com.au]
  • Hypogonadism can be classified into primary hypogonadism as a result of primary testicular disease or secondary hypogonadism as a result of a central defect of the hypothalamus or pituitary gland (Table 1 ).[link.springer.com]
  • disease in young patients.[academic.oup.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]
Small Scrotum
  • Such patients have poor muscle development, a high-pitched voice, inadequate phallic and testicular growth, a small scrotum, sparse pubic and axillary hair, and absent body hair.[merckmanuals.com]
Premature Ejaculation
  • Jannini, Mario Maggi and Andrea Lenzi, Evaluation of Premature Ejaculation, The Journal of Sexual Medicine, 8, s4, (328-334), (2011).[doi.org]

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]
  • Primary Hypogonadism Secondary Hypogonadism Rx of Hypogonadism 2011 Screening and Workup for Testosterone Deficiency Martin M.[enotes.tripod.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]
  • 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]
  • 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 signs and symptoms similar to those of menopause in women. These may include hot flashes, decreased drive, irritability, depression and fatigue.[healthguidance.org]
  • As testosterone decreases, some men may experience symptoms similar to those of menopause in women.[mayoclinic.org]
  • A confounding factor is that SHBG rises with age, and thus free testosterone decreases more rapidly than total testosterone in older men ( 11 ). Thus, it is important to measure bioavailable or free testosterone in men with diabetes.[care.diabetesjournals.org]
Testosterone Increased
  • increased lumbar bone mineral density and quality of life, while nandrolone did not. 49 Opioid analgesia suppresses gonadotropin release, resulting in low levels of circulating testosterone, and there are data indicating that opioid treatment is associated[mja.com.au]
  • Sex hormone- binding globulin (SHBG), the major serum carrier of testosterone, increased by 1.2%/yr, with the net effect that total serum testosterone declined more slowly (0.4%/yr) than the free or albumin-bound pools alone. 32 33.[slideshare.net]
  • S erum testosterone increased in CC-treated men, both pyospermic and nonpyospermic. However, only CC-treated, nonpyospermic men demonstrated improvement in semen characteristics.[jeffreydachmd.com]
  • These abnormalities usually result from Primary Hypogonadism (Disease of the Testes) - Decreased Testosterone (AM fasting total testosterone, Increased LH or FSH - Check testes size.[enotes.tripod.com]
Hematocrit Decreased
  • Check hematocrit; if it increases to 54%, stop therapy until hematocrit decreases into the normal range. Evaluate for OSA or other conditions associated with secondary erythrocytosis. Resume therapy at a lower dose.[clinicaladvisor.com]

Treatment

  • Updated evidence-based prescribing information reflects the latest national clinical practice guidelines and evidence-based treatment guidelines, including the latest clinical treatment guidelines for diabetes. NEW![books.google.com]
  • METHODS: We performed a prospective, randomized, trial assigning 53 hypogonadal men to the following treatment groups: mesterolone 100 mg p.o. daily, testosterone undecanoate 160 mg p.o. daily, testosterone enanthate 250 mg i.m. every 21 days, or a single[ncbi.nlm.nih.gov]
  • Testosterone treatment is contraindicated in subjects with prostate cancer or benign prostate hyperplasia and risks of treatment are perceived to be high by many physicians.[doi.org]
  • This CME supplement discusses the definition, epidemiology and key signs and symptoms of late-onset hypogonadism, the role of lab measurements, factors to consider in selecting patients for testosterone replacement therapy, and how to identify the best treatment[mdedge.com]
  • Karger AG, Basel References Finkelstein JS, Klibanski A, Neer RM, Doppelt SH, Rosenthal DI, Segre GV, Crowley WF: Increases in bone density during treatment of men with idiopathic hypogonadotropic hypogonadism.[karger.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]
  • 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[medbullets.com]
  • […] body system manifestations due to the underlying etiology.[icd10data.com]
  • Prior to initiating therapy with AndroGel 1.62% Determine the specific etiology: If hypogonadism is suspected, identify the underlying medical condition that is causing it 1 Confirm the diagnosis: Investigate a diagnosis of hypogonadism by performing[androgelpro.com]

Epidemiology

  • This CME supplement discusses the definition, epidemiology and key signs and symptoms of late-onset hypogonadism, the role of lab measurements, factors to consider in selecting patients for testosterone replacement therapy, and how to identify the best[mdedge.com]
  • DRG Epidemiology's coverage of male hypogonadism comprises epidemiological...[decisionresourcesgroup.com]
  • Lee 1Arthritis Research Campaign Epidemiology Unit (A.T., T.W.O., D.M.L., A.J.S., J.D.F.), The University of Manchester, Manchester M15 6PB, United Kingdom Search for other works by this author on: Alan J.[academic.oup.com]
  • Bjerkeli, Shai Mulinari and Juan Merlo, Testosterone prescribing in the population—a short social epidemiological analysis in Sweden, Pharmacoepidemiology and Drug Safety, 25, 1, (11-15), (2015). Raymond C. Rosen, Allen D. Seftel, Dustin D.[doi.org]
  • Epidemiology of Adult and Late-Onset Hypogonadism 25. Pathophyisology of Adult and Late-Onset Hypogonadism: Testosterone 26. Pathophyisology of Adult and Late-Onset Hypogonadism: Hypothalamus, Pituitary, Testes 27.[sciencemedia.com]
Sex distribution
Age distribution

Pathophysiology

  • Smith and Sardar Ali Khan, Obesity’s role in secondary male hypogonadism: a review of pathophysiology and management issues, SN Comprehensive Clinical Medicine, 10.1007/s42399-019-00056-7, (2019).[doi.org]
  • Prader-Willi syndrome Neoplastic disorder Craniopharyngioma Germ cell tumors Histocytosis X Inflammatory cause Granulomatosis with polyangiitis Sarcoidosis Infection – Mycobacterium tuberculosis Age-related hypogonadism – pathology in testes and hypothalamus Pathophysiology[arupconsult.com]
  • Published on Apr 27, 2012 Male Hypogonadism :etiology, pathophysiology, prevalence, diagnosis by R.Tavakkolnia MD, urologist 1. HYPOGONADISM:ETIOLOGYEPIDEMIOLOGYPREVALENCE Rahim TavakkolniaDIAGNOSIS urologist 1 2.[slideshare.net]
  • This review will discuss the definitions, pathophysiology, causes, clinical manifestations, appropriate diagnostic testing procedures, and the role of testosterone supplementation with currently available formulations, with special attention to efficacy[ahcmedia.com]

Prevention

  • 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]
  • What Should I Do to Prevent Testicular Cancer? To prevent testicular cancer, all men should be familiar with the size and feel of their testicles, so they can detect any changes.[webmd.com]
  • Testosterone replacement therapy can help restore muscle strength, and prevent bone loss. Replacement also increases energy, sexual function and sex drive, and a sense of well-being.[health.in4mnation.com]
  • Early detection is the best way to manage symptoms and prevent complications that could include infertility in adult men.[performanceinsiders.com]
  • More information Testosterone Deficiency (Primary Hypogonadism and Secondary/Hypogonadotrophic Hypogonadism) Prevention In some cases, hypogonadism is caused by genetic factors and cannot be prevented.[myvmc.com]

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