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HYPOGONADISM IN MALES - LATE-ONSET
Late onset hypogonadism is defined as clinical and biochemical syndrome characterized by older age, set of typical symptoms, and deficiency in serum testosterone levels.
The quality of life may be decreased and multiple organ systems may be adversely affected.
Prior to the start of testosterone substitution, there should be confirmation of low serum testosterone and a confirmation of need based on clinical findings.
Only if the potential benefit exceeds the risk, then replacement testosterone should be started.

Follow Up

  • The patient should be monitored carefully (by monthly check-up every 3 months) for the development of adverse effects

At 1 Month & 3 monthly therafter

  • Follow up w/ patients to assess that the desired testosterone level is achieved
    • Optimal serum testosterone level for efficacy is unknown
    • It is generally recommended that mid to lower young adult levels may be appropriate as the therapeutic goal 
  • Evaluate the patient for complications/adverse effects & determine if symptoms are improving

During 1st Year of Therapy

  • Perform prostate exam, PSA, hematocrit every 3 months
    • Hematocrit >54% requires dose reduction or temporary medication discontinuation
    • If the PSA increases >0.75 ng/mL over 2 consecutive controls or a PSA level abnormal for age (>4 ng/mL), further exam & eventual biopsy may be needed
  • Plasma lipid determinations at the 3rd & 6th month of therapy
  • Liver function test, urinalysis & measurement of bone markers may be done at the 6th month

At 1 Year

  • Repeat all previous tests done on the 6th month
  • Blood glucose control should be evaluated by fasting blood glucose (FBG), post-prandial glucose (PPG) or HbA1c
  • After the 1st year, follow-up may be done every 6 months for 2 years & annually thereafter