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Updated: Sep 26 2022

Male Hypogonadism

  • Introduction
    • Decrease in effective testosterone levels as result of
      • decreased free concentration
        • often as result of decreased production (Leydig and pituitary dysfunction)
        • also result of increased synthesis of SHBG
      • decreased activity at receptor
        • often as result of androgen receptor deficiency
    • May be primary or secondary
      • primary hypogonadism / hypergonadotropic hypogonadism
        • ↓ function of Leydig cells
          • results in ↓ testosterone synthesis
          • any dysfunction isolated to Sertoli cells/seminiferous tubules does not result in ↓ testosterone synthesis
          • if testes are cryptorchid, testosterone production is normal because Leydig cells are not affected by ↑ temperature
        • loss of negative feedback of testosterone results in ↑ LH
        • FSH levels are variable based on presence of inhibin
          • ↑ FSH if seminiferous tubule dysfunction is also present
            • inhibin normally released by Sertoli cells to inhibit FSH
            • if damaged that feedback is lost
          • normal FSH if dysfunction is limited to Leydig cells
        • etiologies include
          • alcoholic liver disease
          • damage to Leydig cells as result of trauma, toxins, inflammation, and irradiation
      • secondary hypogonadism / hypogonadotropic hypogonadism
        • ↓ function of hypothalamus/pituitary
        • results in ↓ LH and FSH synthesis and consequent ↓ testosterone synthesis
        • etiologies include
          • craniopharyngioma
          • pituitary adenoma
  • Presentation
    • Symptoms
      • ↓ secondary male characteristics
      • osteoporosis
        • result of dysregulated osteoclast activity (normally ↓ by testosterone)
      • infertility
        • ↓ sperm count
      • impotence
  • Treatment
    • Testosterone administration
      • Formulations
        • Topical
        • Intramuscular
        • Subcutaneous
      • Contraindications
        • Prostate cancer
        • Breast cancer
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