Hypogonadism Diagnosis and Treatment

Definition and Types

Hypogonadism is a clinical condition characterized by symptoms and biochemical evidence of testosterone deficiency that impacts multiple organ systems and quality of life, as defined by the European Association of Urology 1, 2, 3, 4
Primary (hypergonadotropic) hypogonadism is caused by testicular dysfunction, resulting in low testosterone and high gonadotropin levels, according to the European Urology guidelines 1, 2
Secondary (hypogonadotropic) hypogonadism results from impairment of the hypothalamic-pituitary-gonadal (HPG) axis, as stated by the European Urology guidelines 1, 2
Compensated hypogonadism is characterized by normal testosterone levels with elevated luteinising hormone production, as described by the European Urology guidelines 1
Functional hypogonadism is diagnosed when low testosterone levels occur in the absence of organic alterations in the HPG axis, often as a consequence of comorbidities, according to the European Urology guidelines 1

Hypogonadism presents with sexual symptoms, including diminished libido and erectile dysfunction, as reported by the New England Journal of Medicine 5, 6, 7
Physical symptoms of hypogonadism include reduced muscle mass and strength, increased body fat, diminished bone density, and anemia, as described by the New England Journal of Medicine 6, 8
Psychological symptoms of hypogonadism include diminished energy, increased fatigue, depressed mood, and impaired cognition, as stated by the New England Journal of Medicine 6, 8

Congenital disorders, such as chromosomal abnormalities and Down syndrome, can cause primary hypogonadism, as reported by the European Urology guidelines 1, 2
Acquired disorders, such as testicular trauma and radiation damage, can also cause primary hypogonadism, according to the European Urology guidelines 1, 2
Congenital disorders, such as idiopathic hypogonadotropic hypogonadism and Kallmann syndrome, can cause secondary hypogonadism, as described by the European Urology guidelines 1, 2
Acquired disorders, such as pituitary tumors and traumatic brain injury, can also cause secondary hypogonadism, as stated by the European Urology guidelines 1, 3
Drug-induced hypogonadism can be caused by opiate use, GnRH agonists/antagonists, glucocorticoids, estrogens, and anabolic steroids, as reported by the European Urology guidelines 1, 2, 3

Diagnosis of hypogonadism requires clinical symptoms, including assessment of sexual function, energy levels, mood, and physical changes, as described by the New England Journal of Medicine 6
Biochemical testing, including low serum testosterone levels, is necessary for diagnosis, according to the European Urology guidelines and the New England Journal of Medicine 1, 6

Treatment of underlying conditions is particularly important in functional hypogonadism, as stated by the European Urology guidelines 1

Patients on testosterone therapy require monitoring for erythrocytosis, with a risk varying by administration route, as reported by the New England Journal of Medicine 5, 8
Cardiovascular effects of testosterone therapy are currently considered neutral or possibly beneficial, according to the New England Journal of Medicine 5, 8
Prostate health requires long-term monitoring in patients on testosterone therapy, as stated by the New England Journal of Medicine 5, 8
Other potential side effects of testosterone therapy include fluid retention, sleep apnea, gynecomastia, skin reactions, and testicular atrophy, as described by the New England Journal of Medicine 5, 8