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
- Congenital causes (DUNKY XX):
- 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
- Primary (hypergonadotropic hypogonadism) causes (5):