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Testosterone Therapy in Men with Hypogonadism

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Key Points 2 ➤ Hypogonadism is a clinical syndrome that results from failure of the testis to produce physiological concentrations of testosterone (T deficiency) and/or a normal number of spermatozoa due to pathology at one or more concentrations of the hypothalamic- pituitary-testicular axis. ➤ Testosterone (T) deficiency can be due to testicular defects (primary hypogonadism), hypothalamus-pituitary defects (secondary hypogonadism) or both. • Primary hypogonadism results in low T concentrations, impairment of spermatogenesis, and elevated gonadotropin levels. The causes of primary hypogonadism are listed in Table 1. • Secondary hypogonadism results in low T concentrations, impairment of spermatogenesis, and low or inappropriately normal gonadotropin levels. Causes of secondary hypogonadism are listed in Table 1. • Combined primary and secondary hypogonadism results in low T concentrations, impairment of spermatogenesis, and variable gonadotropin levels. ➤ Additionally, the process of evaluating secondary hypogonadism may uncover a deficiency/excess of other pituitary hormones or a hypothalamic or pituitary tumor that may require management in addition to treating hypogonadism.

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