Primary Hypogonadism (Testicular Failure) |
- Delayed puberty or incomplete development
- Decreased libido
- Infertility
- Gynecomastia
- Small or underdeveloped testes
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- Serum Testosterone Levels: Low levels.
- LH and FSH Levels: Elevated (indicating a primary cause).
- Karyotype Analysis: To detect chromosomal abnormalities like Klinefelter syndrome.
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- Testosterone Replacement Therapy (TRT): To restore normal testosterone levels.
- Fertility Treatment: Assisted reproductive techniques if fertility is desired.
- Monitoring and Management: Regular monitoring of testosterone levels, hematocrit, and PSA in men.
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Secondary Hypogonadism (Hypothalamic or Pituitary Dysfunction) |
- Decreased libido
- Fatigue
- Muscle weakness
- Infertility
- Possible headaches and visual disturbances (if a pituitary tumour is present)
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- Serum Testosterone Levels: Low levels.
- LH and FSH Levels: Low or inappropriately normal.
- MRI of the Brain: To identify pituitary or hypothalamic lesions.
- Serum Prolactin Levels: To assess for hyperprolactinemia.
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- Testosterone Replacement Therapy (TRT): To restore normal testosterone levels.
- Management of Underlying Cause: Surgery, radiation, or medication for pituitary tumours.
- GnRH Therapy: For hypothalamic causes to stimulate gonadotropin release.
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Congenital Causes (e.g., Klinefelter Syndrome, Kallmann Syndrome) |
- Delayed or absent puberty
- Gynecomastia
- Small testes (in Klinefelter syndrome)
- Anosmia (loss of smell in Kallmann syndrome)
- Infertility
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- Karyotype Analysis: To identify chromosomal abnormalities like 47,XXY in Klinefelter syndrome.
- Serum Testosterone, LH, FSH Levels: Low testosterone with elevated LH and FSH in Klinefelter syndrome; low levels in Kallmann syndrome.
- Olfactory Testing: In Kallmann syndrome to confirm anosmia.
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- Testosterone Replacement Therapy (TRT): For development and maintenance of secondary sexual characteristics.
- Fertility Treatment: Assisted reproductive technologies may be needed for fertility.
- Psychosocial Support: Counseling for psychological and social impacts of the condition.
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Acquired Causes (e.g., Trauma, Infection, Chemotherapy/Radiation) |
- Sudden onset of hypogonadal symptoms following trauma or treatment
- Testicular atrophy
- Infertility
- Fatigue and decreased muscle mass
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- Serum Testosterone Levels: Low levels.
- LH and FSH Levels: Elevated in primary causes; low/normal in secondary causes.
- Scrotal Ultrasound: To assess testicular damage.
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- Testosterone Replacement Therapy (TRT): To restore normal testosterone levels.
- Management of Underlying Cause: Treatment or cessation of causative factors (e.g., switching chaemotherapy agents if possible).
- Fertility Treatment: Consideration of sperm banking before treatment that may cause infertility.
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Age-Related Hypogonadism (Andropause) |
- Gradual decrease in libido
- Fatigue and decreased energy levels
- Reduced muscle mass and strength
- Mood changes, irritability
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- Serum Testosterone Levels: Decreased levels typically associated with aging.
- LH and FSH Levels: May be normal or slightly elevated.
- Bone Density Test: To assess for osteoporosis, which may accompany hypogonadism.
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- Testosterone Replacement Therapy (TRT): May be considered based on symptoms and risks.
- Lifestyle Modifications: Diet, exercise, and weight management to improve overall health.
- Monitoring: Regular assessment of testosterone levels, hematocrit, and prostate health in men on TRT.
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