Clinical features and diagnosis of male hypogonadism
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
The clinical features of male hypogonadism are sufficiently well recognized, the causes sufficiently well known, and the tests of the hypothalamic-pituitary-testicular axis sufficiently accurate to permit the diagnosis in most patients.
This topic will review the major clinical features and diagnostic approach to hypogonadism in adult men. The causes and management of primary and secondary male hypogonadism and an overview of hypogonadism in older men are reviewed elsewhere. (See "Causes of primary hypogonadism in males" and "Causes of secondary hypogonadism in males" and "Testosterone treatment of male hypogonadism" and "Overview of testosterone deficiency in older men".)
Hypogonadism in a male refers to a decrease in one or both of the two major functions of the testes: sperm production or testosterone production. These abnormalities can result from disease of the testes (primary hypogonadism) or disease of the hypothalamus or pituitary (secondary hypogonadism). The distinction between these disorders, which will be described below, is made by measurement of the serum concentrations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH):
●The patient has primary hypogonadism if the serum testosterone concentration and/or the sperm count are below normal and the serum LH and/or FSH concentrations are above normal.
●The patient has secondary hypogonadism if the serum testosterone concentration and/or the sperm count are below normal and the serum LH and/or FSH concentrations are normal or low.
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- CLINICAL FEATURES
- Time of onset
- Physical findings
- Biochemical findings
- Candidates for testing
- Initial evaluation
- - Serum total testosterone
- Effect of abnormal SHBG
- - Free testosterone
- - When during the day should the serum testosterone concentration be measured?
- - How often should testosterone be measured?
- LH and FSH
- Semen analysis
- ADDITIONAL TESTING TO DETERMINE ETIOLOGY
- Possible causes
- Primary hypogonadism
- - Karyotype
- Secondary hypogonadism
- - Pituitary function testing
- - MRI
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS