Hypogonadism%20in%20males%20-%20late-onset Diagnosis

• If testosterone level is low or at the lower limit of normal, the level should be repeated for confirmation
• Follicle stimulating hormone (FSH) & luteinizing hormone (LH) levels should also be measured

Primary Hypogonadism (Testicular Origin)

• Low testosterone level w/ increased FSH & LH suggest a testicular failure origin for hypogonadism

Secondary Hypogonadism (Hypothalamic-Pituitary Origin)

• Low testosterone level w/ decreased FSH & LH is suggestive of a hypothalamic-pituitary origin of disease
• Further endocrinological work-up may be needed

• Assessment of androgen deficient related physical manifestations should be noted
• Questionnaires may be used to evaluate climacteric symptoms, the patient’s well-being & sexual function
• Prostate evaluation should be done including measurement of prostate-specific antigen (PSA) & digital rectal exam (DRE)

• Full medical history should be undertaken including:
  
  • Investigation for diabetes mellitus (DM), hypertension, smoking, heart disease, sleep apnea
  • Medication history (eg use of opioids or high-dose glucocorticoid therapy)

• Measure body weight, heart rate (HR), blood pressure (BP), check complete blood count (CBC), urinalysis & blood chemistry parameters

NOTE:

• Serum testosterone level should be obtained between 07:00-11:00 am
• Total testosterone level should be compared w/ the normal ranges established by each laboratory

Testosterone Serum Level

Normal Serum Testosterone

• There are no specific lower limits of normal serum testosterone in older men
• It is generally agreed that total testosterone level >12 nmol/L (345 ng/dL) do not require testosterone substitution

Low Level

• Based on measurements taken in younger men, if total testosterone level is <8 nmol/L (231 ng/dL) then testosterone substitution should be considered

Low-Low/Normal Level

• In patients w/ the following, testosterone substitution may be considered:
  
  • Total testosterone level between 8-12 nmol/L (231-345 ng/dL)

AND

• Presence of above symptoms that are not due to other causes

• Lipid profile & liver function tests are also recommended to assess the patient’s risk status