Adult Male Hypogonadism: A Review - PubMed
4 hours ago
- #testosterone deficiency
- #obesity treatment
- #male hypogonadism
- Adult male hypogonadism is defined by symptoms of testosterone deficiency and consistently low morning serum testosterone levels, with prevalence varying based on cause: less than 1% from hypothalamus, pituitary, or testes issues, and 2% to 8% due to obesity.
- Symptoms include decreased libido, spontaneous erections, and small testes. Primary hypogonadism involves low testosterone with high luteinizing hormone (LH), commonly from Klinefelter syndrome, while secondary hypogonadism features low testosterone with low/normal LH/follicle-stimulating hormone (FSH), often from reversible factors like obesity, illness, or medications, or permanent causes like radiation.
- Diagnosis requires testing only in symptomatic men, confirmed by at least two fasting morning serum testosterone levels below 264-300 ng/dL, with calculated free testosterone assessed in cases like obesity. FSH and LH levels help differentiate primary from secondary types.
- Management prioritizes weight loss for obesity-induced hypogonadism, with at least 5% weight loss improving testosterone and symptoms. Testosterone therapy is reserved for permanent hypogonadism or when causative medications cannot be stopped, tailored to individual needs with monitoring of testosterone, hematocrit, and possibly prostate-specific antigen.