Primary and Secondary Hypogonadism

Santi, Daniele; Corona, Giovanni

doi:10.1007/978-3-319-29456-8_24-1

Cited by 5 publications

(9 citation statements)

References 197 publications

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“…Primary hypogonadism is also called hypergonadotropic hypogonadism, since the pituitary tries compensating the dysfunctional testis by increasing central stimulation. Conversely, in secondary hypogonadism (also called hypogonadotropic hypogonadism), the testis is inadequately stimulated by gonadotropins, usually with inappropriately normal or reduced gonadotropin levels [6,14]. A compensated or subclinical form of hypogonadism, characterised by normal testosterone serum levels and elevated luteinising hormone (LH) production, has also been reported [15]; the clinical significance of the latter condition is unclear [16].…”

Section: Classification and Causes Of Male Hypogonadismmentioning

confidence: 99%

“…A compensated or subclinical form of hypogonadism, characterised by normal testosterone serum levels and elevated luteinising hormone (LH) production, has also been reported [15]; the clinical significance of the latter condition is unclear [16]. Finally, hypogonadism can also result from a group of several conditions leading to reduced sensitivity/insensitivity to testosterone and its metabolites (Supplementary Table 1) [5,14]. This classification, based on the aetiology of hypogonadism, allows the clinician to select appropriate treatment adequately.…”

Section: Classification and Causes Of Male Hypogonadismmentioning

confidence: 99%

“…The phenotype of the hypogonadal patient appears to be independent of the aetiology underlying the problem but is more often affected by the age of onset of hypogonadism. When hypogonadism occurs in adulthood, especially in the case of functional hypogonadism, symptoms can often be relatively mild, difficult to recognise, and frequently confused with the ageing process [5,14] or with comorbid chronic conditions. Several nonspecific clinical features (eg, fatigue, weakness, and decreased energy) as well as sexual impairment may be clinical manifestations.…”

Section: Diagnostic Evaluation Of Male Hypogonadismmentioning

confidence: 99%

“…Conversely, the age of onset of hypogonadism can deeply influence the clinical phenotype [35]. In patients with secondary hypogonadism, both fertility and testosterone normalisation can be achieved theoretically with an adequate treatment, whereas in primary hypogonadism, only testosterone therapy can be considered, which will suppress gonadotropins and endogenous testosterone secretion as well as spermatogenesis (Supplementary Table 1) [5,14]. Hence, testosterone therapy is contraindicated in individuals who desire fertility [36].…”

Section: Treatment Of Lohmentioning

confidence: 99%

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European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction

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Section: Classification and Causes Of Male Hypogonadismmentioning

confidence: 99%

Section: Classification and Causes Of Male Hypogonadismmentioning

confidence: 99%

Section: Diagnostic Evaluation Of Male Hypogonadismmentioning

confidence: 99%

Section: Treatment Of Lohmentioning

confidence: 99%

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European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction

et al. 2021

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“…Since the diagnosis of hypogonadism could be performed using different cut-offs [28,29], we selected those studies in which TT serum levels were reported, alongside the eventual percentage of hypogonadal patients calculated by authors. Thus, the inclusion criteria were:(i) HIV infection, (ii) male sex, and (iii) available TT serum levels.…”

Section: Literature Searchmentioning

confidence: 99%

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Santi

Spaggiari²,

Vena

et al. 2021

Cells

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Background: Hypogonadism is a common comorbidity in human immunodeficiency virus (HIV)-infected men, although the real prevalence is difficult to be estimated. Moreover, in HIV settings, the efficacy of exogenous testosterone (Te) administration at improving body composition remains unclear. Aim of the study: This review has a double aim. First, to estimate the prevalence of pituitary–testis axis abnormality in HIV-infected patients compared to uninfected subjects. Second, to evaluate the effect of androgen administration on body composition in HIV-infected men. Materials and Methods: A systematic review of the literature and meta-analysis was carried out. Two separated literature searches were performed, the first to evaluate the prevalence of Te deficiency in HIV-infected men and the second one to evaluate effects of androgen administration on body composition. Results: The overall prevalence of Te deficiency in HIV-infected men was calculated from 41 studies, showing a 26% prevalence, which was even higher when free T (fT) levels, more than total T, were considered. Indeed, TT serum levels were similar between HIV patients and controls, although higher SHBG and lower fT were detected in HIV populations. When HIV-infected men were treated with exogenous Te, a significant increase in body weight, lean body mass and fat free mass was detected. Conclusion: The systematic review confirms the high prevalence of Te deficiency in HIV-infected men, particularly when fT has been considered. Moreover, chronic androgen supplementation improves body composition, affecting the lean mass compartment. However, considering the general frailty of HIV patients, a tailored indication for Te therapy should be advocated.

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Accurate and time‐saving, two‐step intracavernosal injection procedure to diagnose psychological erectile dysfunction

et al. 2022

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Background:The recognition of the erectile dysfunction pathogenesis is essential to identify the appropriate erectile dysfunction management. As vascular erectile dysfunction could be a manifestation of a systemic arterial damage, the watershed in the erectile dysfunction diagnostic framework is the discrimination between psychological erectile dysfunction and vascular erectile dysfunction. However, reliable tools to directly diagnose psychological erectile dysfunction are currently lacking.Objective: To identify which parameters could predict psychological erectile dysfunction. Moreover, we suggest a new intracavernosal injection procedure to optimize the erectile dysfunction diagnostic workup. Materials and methods:A retrospective, real-world analysis was carried out including all men who underwent intracavernosal injection procedure at the Modena Andrology Unit from 2018 to 2021. A first intracavernosal injection procedure with 5 µg of prostaglandin E-1 (PGE-1) was performed. In the absence of a full drug-induced erection (immediate or delayed), an echo-color Doppler penile evaluation after administration of PGE-1 10 µg was conducted, measuring intracavernosal blood flows, to document a possible vascular etiology. Hormonal evaluations were performed.Results: Out of 179 enrolled patients, 70.4% showed psychological erectile dysfunction, 21.7% vascular erectile dysfunction, and 7.8% hormonal genesis. Multinomial logistic regression analysis identified absence of cardiovascular disease (p = 0.017), presence of spontaneous morning erections (p = 0.018), and normal penile erections with masturbation (p = 0.035) as predictors of psychological erectile dysfunction. Clinically, normal intracavernosal injection test response was detected in 86 patients and abnormal response in 93 subjects. Among the latter, 54 patients experienced a delayed response. The combination of intracavernosal injection test with late penile erections evaluation was able to diagnose psychological erectile dysfunction (sensitivity 97%, specificity 100%), avoiding unnecessary retesting. Discussion:We propose a two-step intracavernosal injection procedure that allows to recognize psychological erectile dysfunction with a high sensitivity/specificity, saving costs and time, and limiting adverse events. Moreover, the presence of spontaneousThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Primary and Secondary Hypogonadism

Cited by 5 publications

References 197 publications

European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction

European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Accurate and time‐saving, two‐step intracavernosal injection procedure to diagnose psychological erectile dysfunction

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