Androgen Deficiency Syndromes

Key Points ÎHypogonadism in men is a clinical syndrome that results from failure of the testis to produce physiological levels of testosterone (androgen deficiency) and a normal number of spermatozoa. ÎPrimary hypogonadism is associated with low testosterone levels, impaired spermatogenesis, and elevated gonadotropin levels. ÎSecondary hypogonadism results in low testosterone levels, impaired spermatogenesis, and low or low-normal gonadotropin levels. ÎAccurate and reliable assays for free or bioavailable testosterone measurements usually are not available in local laboratories and should be performed in a reliable reference laboratory. Screening and Diagnosis: ÎThe Endocrine Society recommends: > making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels. (1⎟ ⊕) > confirmation of the diagnosis by repeating measurement of total testosterone (1⎟ ⊕⊕) and in some patients by measurement of free or bioavailable testosterone level, using an appropriate assay. (2⎟ ⊕) > measurement of serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels to distinguish between primary (testicular) and secondary (pituitary/hypothalamic) hypogonadism. (1⎟ ⊕⊕) > against screening for androgen deficiency in the general population. (1⎟ ⊕) > obtaining seminal fluid analysis in men being evaluated for infertility. (1⎟ ⊕⊕) (The lab performing the analysis should be certified or qualified to perform semen analyses.) ÎThe Endocrine Society suggests: > that a diagnosis of androgen deficiency should not be made during an acute or subacute illness. (2⎟ ⊕⊕) > that clinicians measure serum testosterone level in patients with clinical manifestations shown in Table 1. > the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test. (2⎟ ⊕) > that clinicians also consider measuring serum testosterone level when the less specific symptoms and signs listed in Table 2 occur in conjunction with those listed in Table 1. (2⎟ ⊕⊕) > further evaluation on an individualized basis in men with secondary hypogonadism to identify the etiology of hypothalamic and/or pituitary dysfunction. This evaluation may include measurements of serum prolactin and iron saturation, pituitary function testing, and magnetic resonance imaging (MRI) scanning. (2⎟ ⊕) > obtaining a karyotype if Klinefelter's syndrome is suspected in men with primary testicular failure of unknown etiology. (Elevated LH and FSH, low or low normal serum T, very small testes, azoospermia, gynecomastia, and learning disorder). (2⎟ ⊕) > measurement of bone mineral density by using dual energy x-ray absorptiometry (DXA) scanning in men with severe androgen deficiency or low trauma fracture. (2⎟ ⊕) > that clinicians not use the available case-finding instruments for detection of androgen deficiency in men receiving health care for unrelated reasons. (2⎟ ⊕) > that clinicians consider case detection by measurement of total testosterone levels in men with certain clinical disorders, listed in Table 3, in which the prevalence of low testosterone levels is high. (2⎟ ⊕)

• Cover
• Key Points
• Assessment and Diagnosis
• Selecting a Treatment Regimen
• Monitoring