Diagnosis and Treatment of Primary, Secondary, and Functional Male Hypogonadism: A Narrative Review
Abstract
Male hypogonadism refers to a condition characterized by reduced testosterone production or impaired sperm production. Traditionally, it was classified into two categories: congenital and acquired hypogonadism. However, with the emergence of the concept of functional hypogonadism, which develops as a result of chronic diseases, medications, or aging, male hypogonadism is now considered under three subtypes.
The clinical manifestations and treatment strategies vary depending on the underlying cause of hypogonadism. Additionally, the desire for fertility significantly influences the treatment protocol.
This systematic review examines the diagnostic and therapeutic approaches to primary, secondary, and functional male hypogonadism.
Keywords
Testosterone, Functional Hypogonadism, Fertility, Androgen Deficiency, aging, Late-Onset Hypogonadism
References
- Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society* Clinical Practice Guideline. J Clin Endocr Metab. 2018;103(5):1715-44.
- Tajar A, Huhtaniemi IT, O'Neill TW, Finn JD, Pye SR, Lee DM, et al. Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS). J Clin Endocrinol Metab. 2012;97(5):1508-16.
- Al-Sharefi A, Quinton R. Current National and International Guidelines for the Management of Male Hypogonadism: Helping Clinicians to Navigate Variation in Diagnostic Criteria and Treatment Recommendations. Endocrinol Metab (Seoul). 2020;35(3):526-40.
- Young J, Xu C, Papadakis GE, Acierno JS, Maione L, Hietamaki J, et al. Clinical Management of Congenital Hypogonadotropic Hypogonadism. Endocr Rev. 2019;40(2):669-710.
- Paulsen CA, Gordon DL, Carpenter RW, Gandy HM, Drucker WD. Klinefelter's syndrome and its variants: a hormonal and chromosomal study. Recent Prog Horm Res. 1968;24:321-63.
- Gravholt CH, Chang S, Wallentin M, Fedder J, Moore P, Skakkebaek A. Klinefelter Syndrome: Integrating Genetics, Neuropsychology, and Endocrinology. Endocr Rev. 2018;39(4):389-423.
- Gül S, Vloeberghs V, Gies I, Goossens E. Testicular mosaicism in non-mosaic postpubertal Klinefelter patients with focal spermatogenesis and in non-mosaic prepubertal Klinefelter boys. Hum Reprod. 2024;39(10):2210-20.
- Fruhmesser A, Kotzot D. Chromosomal variants in klinefelter syndrome. Sex Dev. 2011;5(3):109-23.
- Swerdlow AJ, Schoemaker MJ, Higgins CD, Wright AF, Jacobs PA. Cancer incidence and mortality in men with Klinefelter syndrome: a cohort study. J Natl Cancer Inst. 2005;97(16):1204-10.
- Chang S, Skakkebaek A, Davis SM, Gravholt CH. Morbidity in Klinefelter syndrome and the effect of testosterone treatment. Am J Med Genet C Semin Med Genet. 2020;184(2):344-55.