Primary Treatment for Hypogonadism

Diagnosis and Classification

Diagnosis of hypogonadism requires both persistent specific symptoms and confirmed testosterone deficiency through biochemical testing, according to the European Urology guidelines 2
Morning serum total testosterone measurements should be repeated to confirm low levels, as recommended by the Praxis Medical Insights 1
Classification as primary (elevated LH/FSH) or secondary (low/normal LH/FSH) hypogonadism is necessary to guide treatment approach, based on the Praxis Medical Insights guidelines 1

For patients with secondary hypogonadism who are not concerned about fertility, testosterone replacement therapy is an option, as described in The Journal of Urology 3
For patients wishing to preserve fertility, human chorionic gonadotropin (hCG) is the first-line treatment, with a dosage of 500-2500 IU, 2-3 times weekly, according to The Journal of Urology 4
Follicle-stimulating hormone (FSH) may be added after testosterone levels normalize on hCG if needed, as recommended by The Journal of Urology 4

Exogenous testosterone suppresses spermatogenesis and should not be prescribed to men interested in current or future fertility, as stated in The Journal of Urology 4
Recovery of sperm after cessation of testosterone therapy can take months or even years, according to The Journal of Urology 4
For obese patients with secondary hypogonadism, weight loss through diet and exercise can improve testosterone levels, as recommended by the European Urology guidelines 2

Testosterone replacement therapy can improve sexual function and libido, according to the Praxis Medical Insights guidelines 1
Potential improvements in body composition, energy levels, and mood may also occur, as stated in the Praxis Medical Insights guidelines 1

Erythrocytosis (elevated hematocrit) is a potential side effect, particularly with injectable forms of testosterone, as warned by the Praxis Medical Insights guidelines 1
Regular monitoring of hematocrit, PSA, and testosterone levels is essential, as recommended by the Praxis Medical Insights guidelines 1

The treatment algorithm involves confirming diagnosis with symptoms plus low testosterone levels on two separate morning measurements, as recommended by the European Urology guidelines 2
Determining if primary or secondary hypogonadism through LH/FSH levels is necessary, based on the Praxis Medical Insights guidelines 1
Assessing fertility desires and selecting appropriate treatment, such as gonadotropins or testosterone replacement therapy, is crucial, as stated in The Journal of Urology 4