Hypogonadism%20in%20males%20-%20late-onset Diagnosis
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
Evaluation
- 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)
History
- 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)
Physical Examination
- Measure body weight, heart rate (HR), blood pressure (BP), check complete blood count (CBC), urinalysis & blood chemistry parameters
Laboratory Tests
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