Endocrinology Update: Testicular Hypogonadism

Testicular hypogonadism, or androgen deficiency, is defined as a clinical condition resulting from failure of the testes to produce physiologic levels of testosterone and a normal number of spermatozoa because of disruption of the hypothalamic-pituitary-gonadal axis. Testosterone deficiency (TD) is defined as a serum level less than 300 ng/dL on a morning total testosterone test. It is estimated that more than one-third of men 45 years and older have testosterone deficiency. Associated symptoms include decreased libido, erectile dysfunction, decreased physical stamina and strength, depressed mood, fatigue, increased visceral adiposity, sleep disturbance, and/or poor concentration and memory. These conditions have a direct relationship with cardiometabolic parameters, including insulin resistance, hypertension, hyperlipidemia, and endothelial dysfunction in aging men. No single sign or symptom defines TD. Controversy exists relative to the benefits versus risks of testosterone replacement therapy in men with testicular hypogonadism. Benefits include improvements in the symptoms related to deficiency as well as cardiometabolic parameters, yet recent retrospective and observational trials have suggested an increased risk of cardiovascular mortality without a proven direct cause-and-effect relationship.