Endocrine Abstracts

The focus of the new guidelines of the European academy of andrology is on functional hypogonadism since the diagnosis and treatment is more controversial than for organic hypogonadism. It is important to consider functional hypogonadism, only following formal exclusion of organic hypogonadism. Diagnosis should be made on basis of both clinical symptoms as well as the biochemical confirmation of serum repeatedly low morning fasting testosterone. Most specific symptoms are sexual complaints such as low libido and erectile dysfunction. Functional hypogonadism is commonly associated with overweight, metabolic syndrome and /or type 2 diabetes. Lifestyle changes as well as weight reduction should be the first approach in obese men since functional hypogonadism may be reversible. Several drugs may also induce functional hypogonadism and withdrawal should be considered if possible in first instance. Testosterone replacement therapy (TRT) (preferably in first line via transdermal route) can be considered in order to improve sexual symptoms after exclusion of a number of absolute and relative exclusions of contraindications in shared decision with the patient. Positive effects of TRT on endpoints other than sexual symptoms are less well established. Not only improvement of sexual symptoms but also monitoring of serum hematocrit, testosterone and PSA is needed. More data, especially with respect to cardiovascular safety for long term TRT, are needed but may become available in the near future.

Reference

1. European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males: Endorsing organization: European Society of Endocrinology. Giovanni Corona–, Dimitrios G Goulis–, Ilpo Huhtaniemi, Michael Zitzmann, Jorma Toppari, Gianni Forti, Dirk Vanderschueren, Frederick C Wu. Andrology. 2020 Sep;8(5):970-987.