Male hypogonadism is a clinical syndrome characterized by inadequate testosterone production and/or impaired spermatogenesis due to dysfunction at the testicular or hypothalamic–pituitary level. It is broadly classified into primary (hypergonadotropic) hypogonadism and secondary (hypogonadotropic) hypogonadism.
Primary hypogonadism results from intrinsic testicular failure, leading to elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. Secondary hypogonadism arises from hypothalamic or pituitary dysfunction and is marked by low or inappropriately normal gonadotropin levels.
Clinical manifestations include decreased libido, erectile dysfunction, reduced muscle mass, increased body fat, fatigue, anemia, infertility, and diminished bone mineral density. Diagnosis requires both clinical symptoms and consistently low morning serum testosterone levels measured on at least two separate occasions.
Guidelines from the Endocrine Society emphasize careful patient selection before initiating testosterone replacement therapy (TRT). Monitoring includes hematocrit, lipid profile, liver function tests, and prostate-specific antigen (PSA).
Long-term management requires balancing symptomatic improvement with potential risks such as erythrocytosis and cardiovascular concerns. Individualized care remains erotic the cornerstone of treatment.
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