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To differentiate primary from secondary hypogonadism, early morning luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels must be obtained. In addition, men older than 50 years might have low testosterone levels with functional abnormalities at multiple levels of the hypothalamic-pituitary-testicular axis.1,2,3 Hypogonadism in male patients with testicular failure due to genetic disorders (eg, Klinefelter’s syndrome), orchitis, trauma, radiation, chemotherapy, or undescended testes, is known as hypergonadotropic hypogonadism or primary hypogonadism. In contrast, increased age, black ethnicity and family history of prostate cancer unquestionably increase the risk of prostate cancer, which have triggered some countries to roll out national screening for high risk individuals.
A long-lasting formulation of testosterone undecanoate, another testosterone ester, is available in the EU and other countries, but not yet in the US. The testosterone esters, testosterone enanthate or testosterone cypionate, are administered in the office or at home by the patient or a designate. Testosterone injections have been available for at least 50 years and are usually the cheapest choice for treatment.
Commonly, the post-menopausal woman is not called hypogonadal if she is of typical menopausal age. If hypogonadism is caused by a disorder of the central nervous system (e.g., a brain tumor), then this is known as central hypogonadism. Women with hypogonadism do not begin menstruating and it may affect their height and breast development. Hypogonadism can involve just hormone production or just fertility, but most commonly involves both.citation needed There are many possible types of hypogonadism and several ways to categorize them. Sperm development (spermatogenesis) and release of the egg from the ovaries (ovulation) may be impaired by hypogonadism, which, depending on the degree of severity, may result in partial or complete infertility. Hypogonadism means diminished functional activity of the gonads—the testicles or the ovaries—that may result in diminished production of sex hormones.
The goal of replacement therapy is to maintain testosterone in the normal physiological range; therefore, a combination of clinical and biochemical measures should be monitored 6 to 12 weeks after initiating therapy. An existing or prior history of breast cancer is also an absolute contraindication to testosterone replacement therapy. If on DRE the prostate is enlarged or if the PSA level is greater than 4.0 ng/mL, biopsy of the prostate should be undertaken to confirm a diagnosis of prostate cancer or benign prostatic hyperplasia (BPH).3 A healthy male adult patient with a serum testosterone level greater than 400 ng/dL is unlikely to be testosterone deficient, and therefore clinical judgment should be exercised if he has symptoms suggestive of testosterone deficiency. In addition, treatment objectives might include improving sexual dysfunction, intellectual capacity, depression, and lethargy; maintaining bone mineral density and possibly reducing fracture risk; increasing muscle mass and strength; and enhancing the quality of life.1–3,9 The objective of testosterone replacement therapy is to normalize serum testosterone and maintain the level within the eugonadal state.
Several other medical conditions can mimic the symptoms of low testosterone, including depression, sleep apnea, hypothyroidism and anemia, among others. "These may include reduced muscle mass, decreased bone density with a higher risk of fractures, increased chances of developing diabetes, and cardiovascular disease, infertility and depression," Baumgarten said. Low testosterone can affect mental health and energy levels, often causing fatigue, irritability, mood swings and even depression. Prostate cells are stimulated by testosterone, so be extra vigilant about cancer screenings. If you are treated with testosterone, your doctor will need to see you regularly, along with blood tests. Method of treatment depends on the cause of low testosterone, the patient’s preferences, cost, tolerance, and concern about fertility. Hypogonadism can be treated with the use of doctor-prescribed testosterone replacement therapy.
To get a diagnosis of hypogonadism, you need at least two early morning (7–10 AM) blood tests that reveal low testosterone in addition to signs and symptoms typical of low testosterone. But hormone replacement therapy helps improve sex drive, symptoms of depression and energy levels. This may include medicine to help you produce testosterone or long-term testosterone therapy. Most males with symptoms of low testosterone don’t have a problem with their pituitary glands or testicles.
These are responsible for the observed signs and symptoms in both males and females. Low androgen (e.g., testosterone) levels are referred to as hypoandrogenism and low estrogen (e.g., estradiol) as hypoestrogenism. "Lifestyle adjustments like improving sleep, reducing stress, losing weight and increasing physical activity can naturally boost testosterone, particularly in borderline or age-related cases," Baumgarten said.
A long-lasting formulation of testosterone undecanoate, another testosterone ester, is available in the EU and other countries, but not yet in the US. The testosterone esters, testosterone enanthate or testosterone cypionate, are administered in the office or at home by the patient or a designate. Testosterone injections have been available for at least 50 years and are usually the cheapest choice for treatment.
Commonly, the post-menopausal woman is not called hypogonadal if she is of typical menopausal age. If hypogonadism is caused by a disorder of the central nervous system (e.g., a brain tumor), then this is known as central hypogonadism. Women with hypogonadism do not begin menstruating and it may affect their height and breast development. Hypogonadism can involve just hormone production or just fertility, but most commonly involves both.citation needed There are many possible types of hypogonadism and several ways to categorize them. Sperm development (spermatogenesis) and release of the egg from the ovaries (ovulation) may be impaired by hypogonadism, which, depending on the degree of severity, may result in partial or complete infertility. Hypogonadism means diminished functional activity of the gonads—the testicles or the ovaries—that may result in diminished production of sex hormones.
The goal of replacement therapy is to maintain testosterone in the normal physiological range; therefore, a combination of clinical and biochemical measures should be monitored 6 to 12 weeks after initiating therapy. An existing or prior history of breast cancer is also an absolute contraindication to testosterone replacement therapy. If on DRE the prostate is enlarged or if the PSA level is greater than 4.0 ng/mL, biopsy of the prostate should be undertaken to confirm a diagnosis of prostate cancer or benign prostatic hyperplasia (BPH).3 A healthy male adult patient with a serum testosterone level greater than 400 ng/dL is unlikely to be testosterone deficient, and therefore clinical judgment should be exercised if he has symptoms suggestive of testosterone deficiency. In addition, treatment objectives might include improving sexual dysfunction, intellectual capacity, depression, and lethargy; maintaining bone mineral density and possibly reducing fracture risk; increasing muscle mass and strength; and enhancing the quality of life.1–3,9 The objective of testosterone replacement therapy is to normalize serum testosterone and maintain the level within the eugonadal state.
Several other medical conditions can mimic the symptoms of low testosterone, including depression, sleep apnea, hypothyroidism and anemia, among others. "These may include reduced muscle mass, decreased bone density with a higher risk of fractures, increased chances of developing diabetes, and cardiovascular disease, infertility and depression," Baumgarten said. Low testosterone can affect mental health and energy levels, often causing fatigue, irritability, mood swings and even depression. Prostate cells are stimulated by testosterone, so be extra vigilant about cancer screenings. If you are treated with testosterone, your doctor will need to see you regularly, along with blood tests. Method of treatment depends on the cause of low testosterone, the patient’s preferences, cost, tolerance, and concern about fertility. Hypogonadism can be treated with the use of doctor-prescribed testosterone replacement therapy.
To get a diagnosis of hypogonadism, you need at least two early morning (7–10 AM) blood tests that reveal low testosterone in addition to signs and symptoms typical of low testosterone. But hormone replacement therapy helps improve sex drive, symptoms of depression and energy levels. This may include medicine to help you produce testosterone or long-term testosterone therapy. Most males with symptoms of low testosterone don’t have a problem with their pituitary glands or testicles.
These are responsible for the observed signs and symptoms in both males and females. Low androgen (e.g., testosterone) levels are referred to as hypoandrogenism and low estrogen (e.g., estradiol) as hypoestrogenism. "Lifestyle adjustments like improving sleep, reducing stress, losing weight and increasing physical activity can naturally boost testosterone, particularly in borderline or age-related cases," Baumgarten said.
