Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men

Abstract

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter syndrome, Kallmann syndrome, pituitary or testicular disorders, as well as in men with idiopathic, metabolic or iatrogenic conditions that result in testosterone deficiency. These recommendations do not encompass the full range of pathologies leading to hypogonadism (testosterone deficiency), but instead focus on the clinical spectrum of hypogonadism related to metabolic and idiopathic disorders that contribute to the majority of cases that occur in adult men.

BSSM guidelines on testosterone deficiency: a summary

“…3,6 The more signs and symptoms a man has, the more likely he is to have genuine TD. 12,18 However, because TD signs and symptoms can be non-specific and multifactorial in origin, associated with various lifestyle and psychological factors as well as with normal aging, they can also be found in men with normal testosterone levels. 3 Patients at risk of, or suspected of having, TD should therefore receive a thorough physical and biochemical work-up 4,12 (LoE 2, Grade A).…”

“…3 Patients at risk of, or suspected of having, TD should therefore receive a thorough physical and biochemical work-up 4,12 (LoE 2, Grade A). 12 …”

“…5,11 It is important to remember that testosterone levels may also be suppressed by certain medications, such as oral glucocorticoids, opioids and antipsychotics. [12][13][14][15] Table 2 lists the factors associated with an increased prevalence of TD.…”

“…• Testosterone levels below normal, or in the lower quartile range plus raised luteinising hormone (LH) levels, indicates testicular failure, so testosterone therapy should be considered 12,23 • Symptomatic men with increased LH levels but normal testosterone levels should be considered as having testosterone deficiency…”

“…Physical examination should include measurement of height, weight, BMI and waist circumference, assessment of the degree of body hair (including facial and pubic), 12 and examination for the presence and degree of any breast enlargement, and abnormalities of the penis, testicles, scrotum and prostate.…”