Editing Testosterone Deficiency (2018)



'''See Original Guideline'''

'''Includes parts of Chapter 23 from 11th edition of Campell's'''

===== '''Androgen deficiency (AD)''' =====

* '''The term androgen/testosterone deficiency is preferred over hypogonadism'''
* Unlike female menopause, which is a universal process associated with aging, the exact rate of testosterone decline and presenting symptoms are highly variable in men
* True prevalence of AD in the adult male is unknown as a result of inconsistent definitions used in the literature; population-based studies suggest prevalence 2-39%


===== '''Pathophysiology''' =====

* '''Causes classified as primary vs. secondary'''
** '''Primary: caused by testicular failure'''
** '''Secondary: caused by the disruption at the hypothalamic–pituitary–gonadal (HPG) axis level'''

** '''Primary (hypergonadotropic hypogonadism) causes (5):'''
**# '''Congenital causes (DUNKY XX):'''
**## '''Down syndrone'''
**## '''Undescended testis'''
**## '''Noonan’s'''
**## '''Kleinfelters'''
**## '''Y-microdeletions'''
**## '''XX-male'''
**# '''Iatrogenic causes (e.g., bilateral orchiectomy, testicular radiation, chemotherapy)'''
**# '''Testicular trauma'''
**# '''Infection (orchitis)'''
**# '''Auto-immune'''
** '''Secondary (hypogonadotropic hypogonadism) causes (8):'''
**# '''Congenital causes (e.g. Kallman syndrome (congenital deficiency of GnRH))'''
**# '''Pituitary or suprasellar tumors'''
**# '''Pituitary infiltrative disorders (e.g., hemochromatosis, tuberculosis, sarcoidosis, histiocytosis)'''
**# '''Pituitary apoplexy'''
**# '''Medications (i.e. chronic opioid exposure)'''
**# '''Hyperprolactinemia'''
**# '''Severe chronic illness'''
**# '''Systemic illnesses associated with AD:'''
**** '''Diabetes'''
**** '''Obesity'''
**** '''HIV'''
**** '''Myocardial infarction'''
**** '''Stroke'''
**** '''COPD'''
**** '''Respiratory illness'''
**** '''Cancer'''
**** '''Sepsis'''
**** '''Chronic liver disease'''
**** '''Chronic kidney disease;''' renal transplantation appears to reverse the hormonal abnormalities associated with ESRD
**** '''Rheumatoid arthritis'''
**** '''Burn injury'''
**** '''Traumatic brain injury'''
**** '''Surgical stress'''