Pathogenesis, evaluation and treatment of hypogonadism in men

Abstract

Hypogonadism in men is defined as a complex of signs and symptoms due to testosterone deficiency or inappropriate production, which occurs in about 1-2%. Symptoms of hypogonadism depend primarily on the age of the male patients at the time of development of the hypogonadism (pre- or postpubertal). The dominant findings are: impaired puberty, decrease of virilization, infertility or decrease of spermatogenesis, impotence and gynecomastia. Classically hipogonadism is divided into primary (hypergonadotropic) and secondary (hypogonadotropic). The most common causes of primary hypogonadism is Klinefelter’s syndrome, while secondary - pituitary tumors. "Peripheral" hypogonadism results from androgen receptor polymorphism. The role of therapy of hypogonadism is to restore or maintain proper spermatogenesis as well as testosterone replacement therapy. Gonadotropin and testosterone therapy is available in treatment of hypogonadism in men. The treatment strategy depends on the age of patient and the goals of therapy (restore of fertility and/or produce and maintain of virilization). The gonadototropins and GnRH are useful in spermetogenesis stimulation. The testosterone replacement therapy is efficacious and safe. Testosterone esters and gels are widely applied.