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Male hypogonadism

The disruption can be at one or several levels of the hypothalamic – pituitary -gonadal axis

 

Also known by other names as
 androgen deficiency syndrome androgen deficiency syndrome of the ageing male ( ADAM ) andropause late-onset hypogonadism male-menopause partial androgen decline in the ageing male ( PADAM ) testosterone deficiency syndrome

 

Primary- testicular failure abnormality is in the testes most common cause resulting in low testosterone levels , impaired spermatogenesis and elevated gonadotrophins Klinefelter’s syndrome is the most frequent form of male hypogonadism Testicular tumors – can be seen frequently in males ( a quarter of men after treatment would develop testosterone 
deficiency ) Mumps orchitis Congenital anorchidism Cryptorchidism Radiation treatment / chemotherapy Testicular trauma Sertoli cell syndrome Autoimmune syndrome 
( anti-Leydig cell disorder )

 

Secondary- Hypothalamic-hypopituitary origin
 abnormality lies above the level of testes central defects of the hypothalamus or pituitary lead to secondary testicular failure
 Causes include
 hyperprolactinemia isolated ( idiopathic ) hypogonadotropic hypogonadism Kallmann syndrome -hypogonadotropic hypogonadism with anosmia , genetically determined , prevalence one in 10,000 males cranial trauma radiation treatment medications

 

Mixed dysfunction of hypothalamus / pituitary and gonads – combined primary and secondary testicular failure low testosterone levels variable gonadotrophin level impaired spermatogenesis

Causes include
 alcohol abuse ageing chronic infections as HIV corticosteroid treatment haemochromatosis systemic disease as liver failure , uraemia , sickle cell disease

 

Male hypogonadism due to defects of androgen target organs

REFERENCES

  1. Dandona, P, and M T Rosenberg. “A practical guide to male hypogonadism in the primary care setting.” International journal of clinical practice vol. 64,6 (2010): 682-96. doi:10.1111/j.1742-1241.2010.02355.x
  2. eEUA Guidelines on Male Hypogonadism G.R. Dohle (Chair), S. Arver, C. Bettocchi, T.H. Jones, S. Kliesch, M. Punab EAU-Guidelines-Male-Hypogonadism-2015.pdf (uroweb.org)
  3. Ross A, Bhasin S. Hypogonadism: Its Prevalence and Diagnosis. Urol Clin North Am. 2016 May;43(2):163-76. doi: 10.1016/j.ucl.2016.01.002. PMID: 27132573. ( Abstract )

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