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Male hypogonadism — Clinical Guidelines

Overview

Male hypogonadism refers to a condition characterized by deficient production of testosterone, leading to various clinical symptoms including sexual dysfunction, decreased muscle mass, and metabolic disturbances. 1

Diagnosis

Clinical diagnosis involves assessing symptoms and biochemical parameters, including low serum testosterone levels. 1

Exclusion of hypogonadal causes (e.g., chronic illness, medication side effects) is essential. 1

Grading of recommendations follows the GRADE system for evidence-based decision-making. 1

Management

First-line Treatment: Testosterone replacement therapy (TRT) is recommended for symptomatic patients with confirmed hypogonadism, excluding contraindications. 1

- Drug Classes: Testosterone gels and long-acting injectable testosterone preparations are preferred due to their efficacy and safety profiles. 1

Adjunctive Treatments: TRT can improve sexual function, body composition (reducing fat mass and increasing lean mass), and may benefit metabolic parameters like glycometabolism, though effects vary among patients. 1

Special Populations

Vitamin D Deficiency: Moderate vitamin D deficiency can impair spermatogenesis and testicular architecture, potentially affecting testosterone production, though direct implications for hypogonadism management are not explicitly detailed. 2

Elderly: Specific management considerations for elderly patients are not extensively covered in the provided abstracts, though TRT benefits in body composition and sexual function may still apply. 1

Key Recommendations

Clinical diagnosis of adult-onset hypogonadism should integrate both clinical symptoms and biochemical markers, particularly low testosterone levels, for accurate identification. (Evidence: Strong 1)

Offer testosterone replacement therapy to symptomatic hypogonadal men after ruling out contraindications, with testosterone gels and long-acting injectables recommended for their efficacy and safety. (Evidence: Strong 1)

Consider the broader health context, including vitamin D status, as deficiencies may indirectly affect gonadal function and overall health outcomes in men. (Evidence: Moderate 2)

References

1 Isidori AM, Aversa A, Calogero A, Ferlin A, Francavilla S, Lanfranco F et al.. Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE). Journal of endocrinological investigation 2022. link 2 Zamani A, Saki F, Hatami N, Koohpeyma F. Stereological assessment of the effects of vitamin D deficiency on the rat testis. BMC endocrine disorders 2020. link 3 Miner MM, Heidelbaugh J, Paulos M, Seftel AD, Jameson J, Kaplan SA. The Intersection of Medicine and Urology: An Emerging Paradigm of Sexual Function, Cardiometabolic Risk, Bone Health, and Men's Health Centers. The Medical clinics of North America 2018. link 4 Elterman DS, Kaplan SA, Pelman RS, Goldenberg SL. How 'male health' fits into the field of urology. Nature reviews. Urology 2013. link 5 Kirby RS, Kirby M. The urologist as an advocate of men's health: 10 suggested steps toward helping patients achieve better overall health. Urology 2005. link 6 Wilkins D. Patient's response to the research. BMJ (Clinical research ed.) 2003. link

Male hypogonadism