Diagnosis & Management of Male Hypogonadism

Question 1

what test is done for patients with signs and symptoms of hypogonadism

Answer 1

early morning testosterone

Question 2

what is the next step in diagnosis if early morning testosterone is low or normal

Answer 2

low = repeat AM testosterone
normal = hypogonadism unlikely, reassure patient and follow-up

Question 3

what is the next step in diagnosis if the repeat AM testosterone is low or normal

Answer 3

low = measure LH/FSH
normal = hypogonadism unlikely, reassure and follow-up

Question 4

what is the diagnosis in patients with elevated FSH and LH following a low repeat AM testosterone

Answer 4

hypergonadotrophic hypogonadism
(primary hypogonadism)

Question 5

what is the diagnosis in patients with low/inappropriately normal FSH and LH following low repeat AM testosterone

Answer 5

hypogonadotrophic hypogonadism
(secondary hypogonadism)

Question 6

what tests are done to investigate causes of hypergonadotrophic hypogonadism(primary)

Answer 6

genetic studies(karyotyping), iron studies

Question 7

what tests are done to investigate causes of hypogonadotrophic hypogonadism(secondary)

Answer 7

exclude meds, prolactin and pituitary hormones, MRI, iron studies

Question 8

what is tested in testosterone measurement, and when is the ideal time to do it

Answer 8

measure total testosterone and SHGB and use algorithm to give ‘calculated free testosterone’
should be measured between 8-11am

Question 9

what are the aims of treatment for hypogonadism

Answer 9

establish/maintain secondary sexual characteristics, maintain sexual function, improve fertility, improve body composition, improve QOL

Question 10

what is the treatment for male hypogonoadism

Answer 10

testosterone replacement therapy

Question 11

what are the advantages of testosterone transdermal gel

Answer 11

fast onset, convenient, mimics circadian rhythm

Question 12

what are the disadvantages of testosterone transdermal gel

Answer 12

skin irritation possible, interpersonal transfer, non-compliance long term

Question 13

what are the advantages of testosterone undecanoate IM injection

Answer 13

steady testosterone levels, convenient, lower frequency administration improves compliance

Question 14

what are the disadvantages of testosterone undecanoate IM injection

Answer 14

difficult to stop if side-effects, local pain at injection, coughing after injection, contraindicated in bleeding disorders

Question 15

what are the advantages of testosterone enanthate/propionate/cipionate IM injection

Answer 15

easy withdrawal if side-effects, can be self-administered

Question 16

what are the disadvantages of testosterone enanthate/propionate/cipionate IM injection

Answer 16

variable testosterone levels, contraindicated in bleeding disorders, coughing and local pain following injection

Question 17

what are the frequencies of administration of the 2 types of IM testosterone injection

Answer 17

undecanoate = every 10-14 weeks
enanthate = every 2-3 weeks

Question 18

what are the names of the 2 different types of IM testosterone injection used

Answer 18

undecanoate = Nebido
enanthate = Sustanon

Question 19

what are the contraindications to testosterone replacement therapy

Answer 19

hormone responsive cancer(eg breast/prostate), possible prostate cancer, haematocrit <50%, severe sleep apnoea/HF