From the Guidelines
Male hypogonadism is the medical condition when men stop producing sufficient testosterone. This syndrome occurs when the testes don't produce enough testosterone, which can happen due to problems with the testes themselves (primary hypogonadism) or issues with the pituitary gland or hypothalamus (secondary hypogonadism) 1.
Key Points
- Symptoms include reduced sex drive, erectile dysfunction, decreased muscle mass, fatigue, depression, and increased body fat.
- Treatment typically involves testosterone replacement therapy (TRT), which can be administered through injections, transdermal patches or gels, or pellets implanted under the skin.
- The appropriate treatment depends on the cause, severity, and patient preference, as noted in the American College of Physicians' clinical practice guideline 1.
- Regular monitoring of testosterone levels, prostate health, and blood counts is essential during treatment, as the long-term efficacy and safety of testosterone therapy are unknown 1.
- Hypogonadism can result from aging (andropause), genetic conditions, injuries, infections, or certain medications, and proper diagnosis requires blood tests to measure hormone levels and identify the underlying cause.
Considerations
- Testosterone treatment is approved by the U.S. Food and Drug Administration (FDA) for replacement therapy for men with primary or secondary hypogonadism caused by disorders of the hypothalamus, pituitary gland, or testes 1.
- The level of baseline testosterone that prompts initiation of such therapy varies widely, and substantial proportions of U.S. men who receive testosterone therapy do not have testosterone levels tested before initiation of therapy 1.
From the FDA Drug Label
Testosterone Cypionate Injection is indicated for replacement therapy in the male in conditions associated with symptoms of deficiency or absence of endogenous testosterone. Primary hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy. Hypogonadotropic hypogonadism (congenital or acquired)-idiopathic gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.
The syndrome called when men stop making testosterone is Hypogonadism, which can be either Primary or Hypogonadotropic 2.
- Primary hypogonadism is due to testicular failure.
- Hypogonadotropic hypogonadism is due to gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury. Similar information is also found in 3.
From the Research
Definition and Symptoms of the Syndrome
- The syndrome where men stop making testosterone is called hypogonadism, which is defined as a complex of signs and symptoms due to testosterone deficiency or inappropriate production 4.
- Symptoms of hypogonadism depend primarily on the age of the male patients at the time of development of the hypogonadism and can include impaired puberty, decrease of virilization, infertility or decrease of spermatogenesis, impotence, and gynecomastia 4.
Classification of Hypogonadism
- Hypogonadism can be classified into primary (hypergonadotropic) and secondary (hypogonadotropic) forms 4.
- Primary hypogonadism is most commonly caused by Klinefelter's syndrome, while secondary hypogonadism is often caused by pituitary tumors 4.
- "Peripheral" hypogonadism can result from androgen receptor polymorphism 4.
Treatment of Hypogonadism
- The role of therapy for hypogonadism is to restore or maintain proper spermatogenesis as well as testosterone replacement therapy 4.
- Testosterone replacement therapy is efficacious and safe, and can be administered through various methods, including testosterone esters and gels 4, 5.
- The selection of treatment method depends on the patient's preference and the goals of therapy, which can include restoring fertility and/or producing and maintaining virilization 5.