TITLE: MALE HYPOGONADISM
AUTHOR: CHARLES FAIMAN, MD -- Department of Endocrinology
PUBLISHED: JANUARY 7, 2005
Table 1:
Primary (Hypergonadotropic) Hypogonadism: Major Causes
  • Genetic—Klinefelter's syndrome
  • Congenital—Anorchia
  • Toxins—Alcohol, heavy metals
  • Orchitis
  • Trauma
  • Infarction
  • Aging

 

Table 2:
Secondary (Hypogonadotropic) Hypogonadism:
Major Causes
  • Pubertal delay
  • Hypogonadotropism
    • Congenital or acquired
    • Isolated or combined pituitary disease
    • Space-occupying lesions of pituitary/hypothalamus
    • Hyperprolactinemia per se
    • Infiltrative/infectious
    • Suppression:
      • Sex steroids
      • Gonadotropin-releasing hormone analogues
  • Aging?

 

 

 

 

 

 

Table 3:
Conditions Associated with
Male Hypogonadism
  • Aging
  • Chronic illness
    • Diabetes
    • Acquired immunodeficiency syndrome (AIDS)
    • Chronic renal failure
    • Rheumatoid arthritis
  • Cancer cachexia
  • Corticosteroid use

 

Table 4:
Testosterone Preparations
Available in the United States
  • Depot esters (Depo-Testosterone; Delatestryl)
  • Genital skin patch (Testoderm)
  • Nongenital skin patch (Androderm)
  • Gel (Androgel; Testim)
  • Buccal (Striant)

 

Table 5:
Choice of Testosterone Preparation
  
Intramuscular
Gel
Patch
(Genital and nongenital)
Buccal
Convenience
∝
+++
++
?
Stigma
No
No
Yes
No
Physiologic
No
Yes
Yes
Yes
Side Effects
Systemic
Local+
Local+++
Local++
Cost
$
$$$$
$$$
$$$

 

 

 

 

 

 

 

 

Table 6:
Contraindications for Testosterone Replacement
  • Breast carcinoma (history or presence)
  • Prostate carcinoma (history or presence)
  • Severe benign prostatic hyperplasia
  • Abnormal digirectal examinations
  • Elevated levels of prostate-specific antigen
  • Age (no limit established-possibly older than 80)
  • Psychopathology
  • Sleep apnea (potential for worsening)
  • Hypercoagulable states
  • Polycythemia (hematocrit >51%)

 

Table 7:
Potential Benefits of Testosterone Therapy
  • Body composition:
    • Increase in lean body mass
    • Decrease in fat mass
  • Bone:
    • Increased bone density
    • No fracture data available
  • Mood/well-being
  • Sexual function
  • Cognitive function
  • Muscle strength/physical function
  

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