Symptoms of hypogonadism resemble those of ageing; as a consequence, hypogonadism is often overlooked. To prevent this, clinical guidelines have developed diagnostic procedures to confirm hypogonadism in a patient who has symptoms and/or signs of testosterone deficiency. These include symptomatic evaluation, medical history, physical examination and measurement of testosterone levels.
Chronic diseases, such as type 2 diabetes and heart disease, can be associated with low testosterone. Furthermore, certain medications, especially opioids,9-12 selective serotonin reuptake inhibitors (SSRIs),13 statins,14-16 and glucocorticoid medications17,18 may be associated with reduced testosterone levels. Therefore, comorbid conditions must be comprehensively investigated in every patient. Acute illnesses can be associated with the development of functional hypogonadism; in patients with acute illness, measurement of testosterone levels should be postponed.
A study in 169 middle-aged and elderly men with symptomatic benign prostatic hyperplasia, who were otherwise healthy showed excellent correlation (r = 0.849) between plasma testosterone level at first sampling and the mean of 7 samples taken subsequently over 1 year.20 It concluded that in middle-aged and elderly men, a single point plasma testosterone measurement reflect fairly reliably the annual mean testosterone level.21 Furthermore, it imposes additional burden on patients and clinicians. Therefore, a single value showing low testosterone in symptomatic men is usually enough to make the diagnosis of hypogonadism.21
This guidance has been taken from the American Urology Association Guidelines.
|Elevated SHBG --> Reduced free testosterone||Reduced SHBG --> Elevated free testosterone|
|Drugs: anticonvulsant, estrogens, thyroid||Drugs: GH, glucocorticoids, testosterone,|
|hormone||anabolic androgenic steroids|
|AIDS/HIV||Insulin resistance (metabolic syndrome or type 2 diabetes)|
|Non-alcoholic fatty liver disease (NAFLD)
This guidance has been taken from the American Urology Association Guidelines
|Laboratory test||Indication||Clinician response|
Nebido is contraindicated in men with androgendependent carcinoma of the male mammary gland.
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