Male hypogonadism is a condition characterized by insufficient testicular function that results in decreased testosterone and/or impaired sperm production.
To diagnose testosterone deficiency, finding a single low value is not enough.
There must be a combination of:
compatible symptoms/signs + persistently low testosterone, properly confirmed.
Many of these symptoms are nonspecific.
Testing usually begins with morning total testosterone, because of circadian variation.
A low result must be confirmed and then interpreted together with symptoms and the clinical context.
The problem lies mainly at the testicular level.
You may find: low testosterone + elevated LH.
The abnormality lies at the hypothalamic-pituitary level.
You may find: low testosterone + low or inappropriately normal LH.
No.
First we must:
This concept is fundamental: exogenous testosterone suppresses the hypothalamic-pituitary-gonadal axis and can markedly reduce sperm production.
Therefore, testosterone should not be prescribed automatically to a man seeking fertility.
Key concept
We do not treat an isolated lab number. We treat a patient with compatible clinical features and a correctly demonstrated hormonal deficiency.
Andrology does not study sexual function alone. It integrates erectile and ejaculatory function, reproduction, hormonal function, and diseases of the male genital tract.
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