Clinical awareness and diagnosis of male hypogonadism

Male hypogonadism is an underdiagnosed clinical condition. The reasons for this include a lack of clinical awareness, non-specific symptoms and until recently no coherent guidance on how to interpret the biochemical tests. Hypogonadism is defined as a clinical syndrome, which consists of symptoms with or without signs associated with biochemical evidence of testosterone deficiency. Recent international guidelines have helped physicians to make a diagnosis and improved testosterone formulations allow more physiological testosterone replacement. Testosterone levels are not always assessed in men with fatigue or with bone fractures but are more likely to be assessed but again not always in men with symptoms of loss of libido or erectile dysfunction. There is also increasing evidence that low testosterone levels are an independent risk factor for the metabolic syndrome and type 2 diabetes and that there is a high prevalence of hypogonadism in these conditions. All of these are important triggers to the clinician to consider the diagnosis. There is now evidence that testosterone is not only a sex hormone, it has important beneficial effects on metabolism, the cardiovascular system, the brain as well as muscle and bone.