Hipogonadismo en hombres
Resumo
Definição
History and exam
Key diagnostic factors
- libido disminuida
- pérdida de las erecciones espontáneas en la mañana
- disfunción eréctil
- anemia normocítica
- ginecomastia
- subfertilidad
- micropene
- testículos pequeños
- escroto bífido o hipoplásico
- criptorquidia, especialmente si es bilateral
- desproporción segmentaria
- hemianopsia bitemporal
- fracturas por traumatismo leve
- pérdida de peso
- anosmia
Other diagnostic factors
- disminución de la energía y fatiga
- pubertad ausente o incompleta
- hipoplasia escrotal, hipopigmentación y ausencia de rugosidades
- disminución de la fuerza y masa muscular
- pérdida de vello axilar y púbico
- falta de vello facial
- mala concentración y memoria
- estado de ánimo depresivo o lábil
- alteración del sueño
- sofocos y sudores
- estatura alta
- arrugas finas en la piel facial
Risk factors
- anomalía genética
- diabetes mellitus tipo 2
- consumo de fármacos alquilantes, opiáceos o glucocorticoides
- uso de hormonas sexuales exógenas y análogos de la hormona liberadora de gonadotropina (GnRH)
- hiperprolactinemia
- tumor paraselar o apoplejía de macroadenoma hipofisario
- daño testicular
- infección
- varicocele
Diagnostic tests
1st tests to order
- testosterona total en suero
Tests to consider
- globulina fijadora de hormonas sexuales (SHBG) en suero
- testosterona libre calculada
- hormona luteinizante/foliculoestimulante (LH/FSH) sérica
- análisis de semen
- hemograma completo (HC)
- prolactina sérica
- saturación sérica de transferrina y ferritina
- resonancia magnética (IRM) hipofisaria
- pruebas genéticas
- radioabsorciometría de doble energía (DEXA)
Treatment algorithm
enfermedad no gonadal
no desea la fertilidad actualmente: hipogonadismo primario
no desea la fertilidad actualmente: hipogonadismo secundario
deseo de fertilidad actual: hipogonadismo primario
desea la fertilidad actualmente: hipogonadismo secundario
Contributors
Authors
Richard Quinton, MD FRCP(Edin)
Consultant Endocrinologist
Northern Region Gender Dysphoria Service
Tyne & Wear NHS Foundation Trust
Newcastle upon Tyne
UK
Honorary Reader in Reproductive Endocrinology
Department of Metabolism, Digestion and Reproduction
Imperial College London
UK
Disclosures
RQ has received speaker fees and an advisory board fee from Besins Healthcare UK, speaker fees from Androlabs, and was on an advisory board for Roche Diagnostics. RQ is an author of several references 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018 Aug;200(2):423-32.Full text Abstract
Jayasena CN, Anderson RA, Llahana S, et al. Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clin Endocrinol (Oxf). 2022 Feb;96(2):200-19.Full text Abstract
Matsumoto AM. Diagnosis and evaluation of hypogonadism. Endocrinol Metab Clin North Am. 2022 Mar;51(1):47-62. Abstract
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Síndrome de Klinefelter
- macroadenoma hipofisario
- Prolactinoma
More DifferentialsGuidelines
- Guidelines for testosterone replacement therapy in male hypogonadism
- Fertility problems: assessment and treatment
More GuidelinesPatient information
Problemas de erección
Problemas de fertilidad: algunas razones
More Patient information
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