hypogonadism%20in%20males%20-%20late-onset
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.

Hypogonadism%20in%20males%20-%20late-onset Management

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
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 5 days ago

Children who are fully vaccinated against the flu, ie, receive the recommended number of influenza vaccine doses, have a lower risk of acquiring influenza compared with those who are partially vaccinated, a US study found.

06 Jul 2020
Routinely used for treating cardiovascular diseases, statins have been shown to benefit other conditions, and new evidence suggests that using the drug at high intensity reduces the risk of hip or knee replacement, an effect that may be specific to rheumatoid arthritis.
Yesterday
Treatment with levothyroxine appears to have no significant impact on systolic and diastolic heart function in older adults with mild subclinical hypothyroidism as compared with placebo, results of a study have shown.
Pearl Toh, 29 Jun 2020
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.