Summary
Definition
History and exam
Key diagnostic factors
- decreased libido
- loss of spontaneous morning erections
- erectile dysfunction
- gynecomastia
- infertility
- micropenis
- small testes
- bifid or hypoplastic scrotum
- cryptorchidism, especially if bilateral
- segmental dysproportion
- bitemporal hemianopia
- low trauma fractures
- loss of height
- anosmia
Other diagnostic factors
- decreased energy and fatigue
- absent or incomplete puberty
- scrotal hypoplasia, hypopigmentation, and absent rugae
- decreased muscle mass and strength
- loss of axillary and pubic hair
- lack of facial hair
- poor concentration and memory
- depressed or labile mood
- sleep disturbance
- hot flashes and sweats
- 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 analogs
- hyperprolactinemia
- parasellar tumor or apoplexy of pituitary macroadenoma
- testicular damage
- infection
- varicocele
Diagnostic tests
1st tests to order
- serum total testosterone
Tests to consider
- serum sex hormone binding globulin (SHBG)
- calculated free testosterone
- serum LH/FSH
- semen analysis
- CBC
- serum prolactin
- serum transferrin saturation and ferritin
- MRI pituitary
- genetic testing
- dual-energy x-ray absorptiometry (DEXA or DXA)
Treatment algorithm
nongonadal illness
not desiring fertility currently: primary hypogonadism
not desiring fertility currently: secondary hypogonadism
desiring fertility currently: primary hypogonadism
desiring fertility currently: secondary hypogonadism
Contributors
Authors
Richard Quinton, MD FRCP(Edin)
Consultant and Senior Lecturer
Department of Endocrinology, Diabetes & Metabolism
Newcastle upon Tyne Hospitals
Translational & Clinical Research Institute
University of Newcastle upon Tyne
Newcastle upon Tyne
UK
Disclosures
RQ has received speaker fees from Besins Healthcare UK. RQ is an author of a reference cited in this topic.
Channa N. Jayasena, PhD FRCP FRCPath
Consultant and Reader in Reproductive Endocrinology/Andrology
Department of Investigative Medicine
Hammersmith Hospital
Imperial College London
London
UK
Disclosures
CNJ has an investigator-led research grant from LogixX Pharma Ltd. CNJ is supported by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship. CNJ is an author of several references cited in this topic.
Acknowledgements
Dr Richard Quinton and Dr Channa N. Jayasena would like to gratefully acknowledge Dr Charles Welliver, Dr T. Hugh Jones, Dr Milena Braga-Basaria, and Dr Shehzad Basaria, previous contributors to this topic.
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. 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 macroadenoma
- Prolactinoma
- Hyperprolactinemia
More DifferentialsGuidelines
- The British Society for Sexual Medicine guidelines on male adult testosterone deficiency, with statements for practice
- Hormones and aging: an Endocrine Society scientific statement
More GuidelinesPatient information
Erection problems
Fertility problems: some reasons
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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