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Male hypogonadism: pathogenesis, diagnosis, and management
Nipun Lakshitha De Silva1, Nikoleta Papanikolaou2, Mathis Grossmann3
1Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
The Lancet. Diabetes & Endocrinology
|August 19, 2024
Summary
Testosterone therapy may improve sexual function in men with functional hypogonadism. While generally safe in the short term, evidence for preventing fractures or type 2 diabetes is insufficient.
Area of Science:
- Endocrinology
- Men's Health
- Reproductive Medicine
Background:
- Organic male hypogonadism from hypothalamic-pituitary-testicular (HPT) pathology is well-managed with testosterone replacement.
- Controversy exists regarding testosterone use in symptomatic men with low testosterone due to non-gonadal factors (functional hypogonadism) without clear HPT axis pathology.
- Health optimization is the primary management for functional hypogonadism.
Purpose of the Study:
- To review the pathogenesis and diagnosis of male hypogonadism.
- To critically appraise the evidence for testosterone therapy in functional hypogonadism.
- To discuss the safety and efficacy of testosterone in specific patient populations.
Main Methods:
- Review of large clinical trials and meta-analyses on testosterone therapy.
- Analysis of data concerning cardiovascular and prostate cancer risks.
- Evaluation of evidence for testosterone's effects on bone mineral density and insulin sensitivity.
Main Results:
- Testosterone therapy shows modest, statistically significant improvements in sexual function for men with functional hypogonadism.
- Short- to medium-term risks for cardiovascular events and prostate cancer were not increased.
- Bone mineral density and insulin sensitivity improved, but evidence for fracture or type 2 diabetes prevention remains insufficient.
Conclusions:
- Testosterone therapy can benefit sexual function in functional hypogonadism, with acceptable short-term safety profiles.
- Further research is needed to establish long-term safety and efficacy for fracture and type 2 diabetes prevention.
- Management of functional hypogonadism should prioritize health optimization alongside considering testosterone therapy.
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