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For further information, see CMDT Part 26-30: Male Hypogonadism
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Essentials of Diagnosis
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Diminished libido and erections
Fatigue, depression, reduced exercise endurance
Small or normal testes; low serum total testosterone or free testosterone level
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
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General Considerations
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Caused by deficient testosterone secretion by the testes
In hypogonadotropic form, FSH and LH deficiency may be isolated or accompanied by other pituitary hormone abnormalities
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Hypogonadotropic hypogonadism (Low testosterone with normal or low LH)
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Hypergonadotropic hypogonadism (Testicular Failure with high LH)
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Causes (Table 26–13)
Male climacteric (andropause)
Klinefelter syndrome: at least one Y chromosome and at least two X chromosomes (47,XXY et al)
Orchitis, eg, mumps, gonorrhea, tuberculosis, leprosy
Testicular failure secondary to radiation therapy or chemotherapy
Autoimmune, uremia, testicular trauma or torsion, lymphoma, myotonic dystrophy, androgen insensitivity
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Delayed puberty if congenital or acquired during childhood
Decreased libido with acquired hypogonadism in most
Erectile dysfunction, hot sweats, fatigue, or depression
Infertility, gynecomastia, headache (if pituitary tumor)
Decreased body, axillary, beard, or pubic hair but only after years of severe hypogonadism
Loss of muscle mass and weight gain due to increased subcutaneous fat
Testicular size, as assessed with orchidometer, may decrease but usually remains normal in length (> 6 cm) in postpubertal hypogonadotropic hypogonadism
In Klinefelter syndrome, manifestations are variable
Generally, testes normal in childhood, but usually become small, firm, ...