Male Hypogonadism

Question 1

Male hypogonadism

Answer 1

the failure of the testes to produce testosterone, sperm or both

Question 2

features of Male hypogonadism

Answer 2

small testes, decreased libido, erectile dysfunction, loss of pubic hair, decreased muscle bulk, increased fat, gynaecomastia, osteoporosis, low mood.

If pre-pubertal: decreased virilization, incomplete puberty, enuchoid body, reduced secondary sex characteristics.

Question 3

primary Male hypogonadism

Answer 3

due to testicular failure - high LH and FSH and low testosterone

Question 4

causes of primary Male hypogonadism

Answer 4

congenital: Klinefelter’s etc

acquired:

• testicular tortion/trauma
• chemo/irradiation

post-orchitis eg mumps, HIV, leprosy

renal failure, liver cirrhosis or alcohol excess

Question 5

secondary Male hypogonadism

Answer 5

decreased gonadotrphins (LH and FSH) and low testosterone

Question 6

causes of secondary Male hypogonadism

Answer 6

• Congenital/idiopathic: IHH (including Kallman’s and CAH)
• Hypopituitarism
• Hypothalamic or pituitary tumours (prolactinoma – hyperprolactinemia)
• Kallman’s syndrome
• Systemic illness (e.g. COPD, HIV), exercise, weight changes, stress
• Infiltrative disease, e.g. sarcoidosis, haemachromatosis
• Cranial irradiation/trauma
• Drugs e.g. anabolic steroids, opiates
  
  • Prader-Willi syndrome
    *

Question 7

if someone presents with signs and symptoms of hypogonadism, what does one do

Answer 7

measure total testosterone concentration in semen in morning

if testosterone is normal, hypogonadism is unlikely

if <9.7/10.4 nmol/L, repeat measurement and also measure SHBG

if still low, measure LH and FSH

= primary/secondary hypogonadism

Question 8

Klinefelter’s syndrome

Answer 8

the most common congenital cause of primary hypogonadism in men

47XXY or mosaicism

Question 9

what are the clinical features of Klinefelter’s syndrome

Answer 9

reduced testicular volume (small testes)

gynaecomastia

eunuchoidism

decreased cognition, libido and sexual maturation

azoospermia

Question 10

eunuchoidism

Answer 10

tall with disproportionate arms and legs

indicating low levels of testosterone

Question 11

azoospermia

Answer 11

semen contains no sperm due to lack of transport via the vas deferens, is assoicated with infertility

Klinefelter’s syndrome

Question 12

testosterone replacement in men

Answer 12

there is clear evidence for this in young men

the evidence for it in older men is less robust

there is controversy on the role of testosterone on CV risk

Question 13

will testosterone restore fertility

Answer 13

no

it may act as a contraceptive due to the inhibitory actions on FSH and LH

Question 14

health benefits of testosterone

Answer 14

improved sexual function: improved erectile function

bone health: improved spine and hip BMD

body composition/muscle strength - decreaesd fat mass and improved limb strength

QOL and cognition