Male hypogonadism in the primary care clinic

Hypogonadism is common in clinical practice but is frequently unrecognized and underdiagnosed. The common causes of male hypogonadism vary with the age of presentation. The overall prevalence of male hypogonadism based upon low serum total testosterone levels is high and increases with age. There are many pitfalls in making the diagnosis of male hypogonadism. First, male hypogonadism is sometimes difficult to recognize because the signs and symptoms are often nonspecific and overlap with other common syndromes. Second, the biochemical diagnosis of male hypogonadism is not straightforward because it might not be clear which testosterone assay to select from the many that are available. Finally, even after the diagnosis of male hypogonadism is made, the patient and clinician must weigh the potential benefits and risks of androgen replacement therapy. However, new diagnostic tools and therapies are making decisions easier.