E29.1
DESCRIPTION
Reduced testosterone due to hypothalamic/pituitary hypofunction or primary testicular failure.
Investigations
- Morning (08h00–09h00) serum total testosterone.
- LH and FSH
| Serum testosterone | LH and FSH | |
|---|---|---|
| Primary testicular failure | Below normal | Above normal |
|
Secondary (hypothalamic/pituitary) hypogonadism |
Below normal | Normal or below normal |
Note: If the serum total testosterone concentration is borderline low repeat the test before replacement therapy is initiated. Don’t test during serious illness.
- Measure serum prolactin
- Sperm count, if infertility is a consideration.
- Further investigations to determine cause to be undertaken after referral; consult a specialist.
MEDICINE TREATMENT
Screen hypogonadal men for prostate cancer before beginning testosterone replacement. Testosterone therapy can induce prostatic hypertrophy, polycythaemia, liver dysfunction, sleep apnoea and hyperlipidaemia. Baseline investigations for these are required prior to initiation of therapy and long-term surveillance is required.
Individualise dosage and review doses based on clinical response.
- Testosterone cypionate, deep IM, 200–300 mg every 2–4 weeks.
- Monitor patients for prostate cancer during treatment.
- Monitor haematocrit. If haematocrit ≥ 54%, stop testosterone therapy.