Summary
Definition
History and exam
Key diagnostic factors
- decreased libido
- loss of spontaneous morning erections
- erectile dysfunction
- gynaecomastia
- infertility
- galactorrhoea
- micro-penis
- small testes
- bifid scrotum
- cryptorchidism
- eunuchoid proportions
- bitemporal hemianopia
- low trauma fractures
- loss of height
- anosmia
Other diagnostic factors
- decreased energy and fatigue
- delayed puberty
- lack of scrotal hyper-pigmentation and rugae
- decreased muscle mass and strength
- loss of axillary and pubic hair
- lack of facial hair
- poor concentration and memory
- depressed mood
- sleep disturbance
- hot flushes and sweats
- increasing BMI
- tall stature
- fine wrinkling of facial skin
Risk factors
- genetic anomaly
- type 2 diabetes mellitus
- use of alkylating agents, opioids, or glucocorticoids
- use of exogenous sex hormones and GnRH analogues
- hyperprolactinaemia
- pituitary tumour or apoplexy
- critical illness
- testicular damage
- varicocele
- auto-immune testicular damage
Diagnostic investigations
1st investigations to order
- serum total testosterone
Investigations to consider
- serum sex hormone binding globulin (SHBG)
- serum free testosterone
- serum bioavailable testosterone
- serum LH/FSH
- serum prolactin
- serum Fe, TIBC, and ferritin
- MRI pituitary
- semen analysis
- genetic testing
- serum TSH
- dual-energy X-ray absorptiometry (DEXA or DXA)
Treatment algorithm
primary
secondary
Contributors
Authors
Charles Welliver, MD
Assistant Professor of Surgery
Division of Urology
Albany Medical College
Albany
NY
Disclosures
CW has worked as a consultant for Coloplast, and as an investigator for Auxilium Pharmaceuticals, Mereo BioPharma, PROCEPT BioRobotics, and Repros; and he is a paid reviewer at Oakstone Publishing and BMJ Best Practice. CW also has a family member who is an employee at Bristol-Myers Squibb.
Acknowledgements
Dr Charles Welliver would like to gratefully acknowledge Matthew Aoun for his help with updating this topic. He would also like to acknowledge Dr T. Hugh Jones, Dr Milena Braga-Basaria, and Dr Shehzad Basaria, previous contributors to this monograph. THJ and SB are authors of references cited in this topic. MB declared that she had no competing interests.
Peer reviewers
Randal J. Urban, MD
Professor
Department of Internal Medicine
University of Texas Medical Branch
Galveston
TX
Disclosures
RJU declares that he has no competing interests.
Niki Karavitaki, MBBS, MSc, PhD
Consultant Endocrinologist
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
Oxford
UK
Disclosures
NK declares that she has no competing interests.
Differentials
- Pituitary macro-adenoma
- Prolactinoma
- Hyperprolactinaemia
More DifferentialsGuidelines
- Testosterone therapy in adult men with androgen deficiency syndromes
- Guidelines on male infertility
More GuidelinesPatient leaflets
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