Hypogonadism: Prevalence, Diagnosis, Physiological Aspects, and Causes

Similar to many other endocrinologic disease states, hypogonadism is a multifactorial disorder with clinical sequelae that reach well beyond those of just androgen deficiency. This syndrome results from failure of the testes to produce physiological levels of testosterone due to disruption of 1 or more levels of the hypothalamic-pituitary-gonadal axis. The condition affects 2 to 4 million men in the United States and becomes increasingly prevalent with age. Modern-day factors, such as increased life expectancy and the rising prevalence of obesity and type 2 diabetes mellitus, are expected to further raise the incidence of male hypogonadism. Although increased clinical awareness of the effects of hypogonadism and the growing interest in hormone replacement therapy for men and women have certainly helped rescue this condition from medical obscurity, fairly recent estimates indicate that only 5% of affected men receive treatment. Appropriate assessment includes proper interpretation of a variety of endocrine markers and recognition of correlating yet subtle signs and symptoms. (Adv Stud Pharm. 2006;3(4):136-141) S imilar to many other endocrinologic disease states, hypogonadism is a multifactorial disorder with clinical sequelae that reach well beyond those of just androgen deficiency. This syndrome results from failure of the testes to produce physiological levels of testosterone due to disruption of 1 or more levels of the hypothalamicpituitary-gonadal axis. The condition affects 2 to 4 million men in the United States and becomes increasingly prevalent with age. One study reported that approximately 12%, 20%, 30%, and 50% of men in their 50s, 60s, 70s, and 80s, respectively, are hypogonadal. Modern-day factors, such as increased life expectancy and the rising prevalence of obesity and type 2 diabetes mellitus, are expected to further raise the incidence of male hypogonadism. Although increased clinical awareness of the effects of hypogonadism and the growing interest in hormone replacement therapy for men and women have certainly helped rescue this condition from medical obscurity, fairly recent estimates indicate that only 5% of affected men receive treatment.