To whom should an adult male patient with no axillary body hair be referred?

Referral for Adult Male Patient with No Axillary Hair

An adult male patient with no axillary hair should be referred to an endocrinologist for evaluation of potential hypogonadism or other endocrine disorders. 1

Initial Assessment

Before referral, consider these key aspects:

1. Absence of axillary hair pattern:

   • Axillary hair development is androgen-dependent and typically appears during puberty
   • Complete absence in an adult male strongly suggests an underlying endocrine disorder

2. Associated clinical features to document:

   • Other secondary sexual characteristics (facial hair, pubic hair, body hair distribution)
   • Voice characteristics (high-pitched suggests androgen deficiency)
   • Genital development (testicular size, penile development)
   • Muscle mass and fat distribution
   • Presence of gynecomastia

Diagnostic Considerations

The absence of axillary hair in adult males may indicate:

1. Primary hypogonadism:

   • Testicular failure due to cryptorchidism, orchitis, or orchidectomy 2
   • Results in low testosterone production

2. Hypogonadotropic hypogonadism:

   • Gonadotropin or LHRH deficiency 2
   • Pituitary-hypothalamic dysfunction

3. Other endocrine disorders:

   • Thyroid dysfunction
   • Growth hormone abnormalities
   • Hyperprolactinemia 3

Referral Algorithm

1. First-line referral: Endocrinologist

   • For comprehensive hormonal evaluation
   • To assess testosterone levels and other endocrine parameters

2. Secondary referrals (based on endocrinology findings):

   • Urologist: If structural abnormalities or urinary symptoms are present 1
   • Dermatologist: If other skin or hair abnormalities are identified

Pre-Referral Laboratory Testing

While awaiting endocrinology consultation, consider ordering:

• Total and free testosterone levels
• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
• Thyroid function tests
• Prolactin levels

Treatment Considerations

Treatment will depend on the underlying cause but may include:

• Testosterone replacement therapy for confirmed hypogonadism 2
• Management of other identified endocrine disorders
• Monitoring for potential complications of hypogonadism (osteoporosis, cardiovascular risk)

Important Caveats

• Absence of axillary hair alone is not diagnostic but requires comprehensive evaluation
• Normal androgen levels do not exclude androgen insensitivity or local 5-alpha-reductase deficiency
• Some patients may have genetic variations in hair follicle sensitivity to androgens
• Distinguish from acquired hair loss conditions which typically show hair follicle remnants rather than complete absence

The endocrinologist will be best positioned to coordinate care and determine if additional specialty consultations are needed based on their findings.