Hypogonadism in men

Guidelines recommend against indiscriminate screening for hypogonadism in the general population.[1]Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018 Aug;200(2):423-32. https://www.auajournals.org/doi/10.1016/j.juro.2018.03.115 http://www.ncbi.nlm.nih.gov/pubmed/29601923?tool=bestpractice.com [2]Jayasena CN, Anderson RA, Llahana S, et al. Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clin Endocrinol (Oxf). 2022 Feb;96(2):200-19. https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.14633 http://www.ncbi.nlm.nih.gov/pubmed/34811785?tool=bestpractice.com [34]Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44. https://academic.oup.com/jcem/article/103/5/1715/4939465 http://www.ncbi.nlm.nih.gov/pubmed/29562364?tool=bestpractice.com [38]European Association of Urology. EAU guidelines on sexual and reproductive health. 2024 [internet publication]. https://uroweb.org/guidelines/sexual-and-reproductive-health

However, clinicians should consider case detection by measurement of total testosterone levels in men with the following clinical disorders, in which the prevalence of low testosterone levels is high or for whom testosterone therapy is suggested or recommended:[1]Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018 Aug;200(2):423-32. https://www.auajournals.org/doi/10.1016/j.juro.2018.03.115 http://www.ncbi.nlm.nih.gov/pubmed/29601923?tool=bestpractice.com [34]Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44. https://academic.oup.com/jcem/article/103/5/1715/4939465 http://www.ncbi.nlm.nih.gov/pubmed/29562364?tool=bestpractice.com

• Sellar mass, radiation to the sellar region, or other diseases of the sellar region

• Treatment with medications that affect testosterone production or metabolism: for example, glucocorticoids, ketoconazole, and opioids

• History of chemoradiation therapy for childhood cancer

• HIV-associated weight loss (uncommon in developed countries)

• Infertility

• Osteoporosis or low trauma fracture

• Unexplained normochromic, normocytic anemia

• Vasomotor sweating or hot flashes

• Glandular gynecomastia

• Decreased libido or erectile dysfunction.