Diagnosis Of Male Hypogonadism Research Articles

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Patients remain misinformed or underinformed about the indications and risks associated with testosterone replacement therapy (TRT), despite the Food and Drug Administration's Drug Safety Communications regarding testosterone products. 1 FDA Postmarket Drug Safety Information. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm161874.htm Google Scholar Most patients are unaware of the association between low serum testosterone, medical comorbidities, such as obesity, diabetes mellitus, and obstructive sleep apnea, and generally unhealthy lifestyles, characterized by stress, lack of physical exercise, poor sleep hygiene, and poor dietary intake. Thanks to modern lifestyles, a large proportion of the population already experiences the nonspecific symptoms associated with testosterone deficiency. Increased patient demand for serum testosterone evaluation, therefore, easily translates to an increase in the diagnosis of male hypogonadism.

Abstract #1010: Reliability of the Androgen Deficiency in Aging Male Questionnaire as a Surrogate to Biochemical Diagnosis of Male Hypogonadism in Black Sub-Saharan Africans with Diabetes Mellitus

Abstract #1010: Reliability of the Androgen Deficiency in Aging Male Questionnaire as a Surrogate to Biochemical Diagnosis of Male Hypogonadism in Black Sub-Saharan Africans with Diabetes Mellitus

Traitement androgénique des hypoandrismes masculins

The diagnosis of male hypogonadism should be clearly established on a clinical and biological basis before considering the initiation of a substitutive treatment with androgens. A careful evaluation of advantages, constraints and limitations of the treatment should be done previously. The potential advantages of an androgenic substitution include an improvement of the symptoms of hypogonadism and the prevention of its bone and metabolic consequences. Absolute (namely prostatic) or relative contraindications should be detected before starting any substitution. The modalities of treatment will be adapted to both the patient's age and the goals to reach. The different available formulations do not induce a similar pattern of plasma testosterone levels. Patches, gel applications and long-acting intramuscular formulations [injected every 3 months] result in stable plasma levels in the physiologic range. The main limitation to their use is linked to a financial aspect as they are not the object of any refund. A careful survey (on clinical, biological and radiological basis) should be established after starting the substitutive treatment with androgens.

Diagnosis of male hypogonadism: what is low testosterone

In contrast to primary hypogonadism, whereby the rise of gonadotropin levels helps establishing a diagnosis, the diagnosis of secondary hypogonadism relies for the most part, on the identification of a low testosterone level in the right clinical context. Establishing that a patient indeed has a low testosterone level requires taking into account several physiological as well analytical aspects. The vast majority of testosterone in men circulates in plasma bound to albumin (50%), sex-steroid binding globulin (SHBG) (44%) and other proteins (4%), while only 2% is found free. The biologically active fraction consists of the free and the albumin-bound fractions. Testosterone levels are highest in the early morning and lowest during the summer. Both total and free testosterone decline with age, as SHBG levels increase. Conditions such as obesity and diabetes also result in diminished testosterone concentrations, while they are accompanied by low SHBG levels. Currently, measurement of total testosterone in hospital laboratories is usually performed on fully automated immunoassay analyzers. Although tandem mass spectrometry methods after gas or liquid chromatography are the most accurate means for testosterone measurement, they are still not widely available in most clinical laboratories. In some cases the concentration of total testosterone may not always represent a true reflection of the patient androgen status and therefore an estimate of the non-SHBG or bioavailable fraction may be a more appropriate measure. Methods of assessment of the non-SHBG-bound fraction of testosterone include estimation of the free concentration by methods including the calculation of the free androgen index (FAI), equilibrium dialysis, centrifugal ultrafiltration, direct analog RIA or calculation of the free fraction.

Comparison of serum testosterone and estradiol measurements in 3174 European men using platform immunoassay and mass spectrometry; relevance for the diagnostics in aging men

The limitations of serum testosterone and estradiol (E(2)) measurements using non-extraction platform immunoassays (IAs) are widely recognized. Switching to more specific mass spectrometry (MS)-based methods has been advocated, but directly comparative data on the two methods are scarce. We compared serum testosterone and E(2) measurements in a large sample of middle-aged/elderly men using a common platform IA and a gas chromatography (GC)-MS method, in order to assess their limitations and advantages, and to diagnose male hypogonadism. Of subjects from the European Male Aging Study (n=3174; age 40-79 years), peripheral serum testosterone and E(2) were analyzed using established commercial platform IAs (Roche Diagnostics E170) and in-house GC-MS methods. Over a broad concentration range, serum testosterone concentration measured by IA and MS showed high correlation (R=0.93, P<0.001), which was less robust in the hypogonadal range (<11 nmol/l; R=0.72, P<0.001). The IA/MS correlation was weaker in E(2) measurements (R=0.32, P<0.001, at E(2) <40.8 pmol/l, and R=0.74, P<0.001, at E(2) >40.8 pmol/l). Using MS as the comparator method, IA ascertained low testosterone compatible with hypogonadism (<11 nmol/l), with 75% sensitivity and 96.3% specificity. The same parameters with IA for the detection of low E(2) (<40.7 pmol/l) were 13.3 and 99.3%, and for high E(2) (>120 pmol/l) 88.4 and 88.6%. A validated platform IA is sufficient to detect subnormal testosterone concentrations in the diagnosis of male hypogonadism. The IA used for E(2) measurements showed poor correlation with MS and may only be suitable for the detection of high E(2) in men.

Clinical awareness and diagnosis of male hypogonadism

Abstract 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 t...

Determination of testosterone in serum by liquid chromatography-tandem mass spectrometry

Commercial direct immunoassays for serum testosterone sometimes result in inaccuracies in samples from women and children, leading to misdiagnosis and inappropriate treatment. The diagnosis of male hypogonadism also requires an accurate testosterone assay method. We therefore developed a sensitive and specific stable‐isotope dilution liquid chromatography‐tandem mass spectrometric (LC‐MS/MS) method for serum testosterone at the concentrations encountered in women and children. Testosterone was extracted with ether‐ethyl acetate from 250 µL or 500 µL of serum. Instrumental analysis was performed on an API 2000 tandem mass spectrometer in the multiple‐reaction monitoring (MRM) mode after separation on a reversed‐phase column. The MRM transitions (m/z) were 289/97 for testosterone and 291/99 for d2 testosterone. The calibration curves exhibited consistent linearity and repeatability in the range 0.2–100 nmol/L. Interassay CVs were 4.2–7.6 % at mean concentrations of testosterone of 3.3–45 nmol/L. Total measurement uncertainty (U, k = 2) was 12.9 % and 13.4 % at testosterone levels of 2.0 nmol/L and 20 nmol/L, respectively. The limit of detection was 0.05 nmol/L (signal‐to‐noise ratio = 3) and the overall method recovery of testosterone was 95 %. Correlation (r) with our in‐house extraction RIA was 0.98 and with a commercial RIA 0.92. Reference intervals for adult males and females in age groups 18–30, 31–50, 51–70 and over 70 years were established. Sensitivity and specificity of the LC‐MS/MS method offer advantages over immunoassay and make it suitable for use as a high‐throughput assay in routine clinical laboratories. The high equipment costs are balanced by higher throughput together with shorter chromatographic run times.

Advances in male hormone substitution therapy

Increased awareness of the clinical diagnosis of male hypogonadism has resulted in the wider use of androgen substitution therapy. Clinical signs and symptoms together with a low serum testosterone level confirm the diagnosis of male hypogonadism. Androgen replacement results in improved sexual function, mood, muscle mass and bone density in most hypogonadal men. Such benefits must be assessed against potential risks. In older men, the potential risks of androgen treatment of hypogonadism are not known. Many delivery systems for androgen substitution are now available; the preparation chosen depends on the choice of the patient and his physician. Selective androgen receptor modulators offer tissue selective biological effects and the possibility of attaining maximum efficacy and minimum adverse effects.

Niftolide tests used in the diagnosis of male hypogonadism

Comparative analysis with an antiandrogen niftolide and synthetic GnRF was carried out in 22 normal subjects, 14 patients with primary and 20 ones with secondary hypogonadism, and in 5 patients with clinical signs of gonadal insufficiency and obscure diagnosis in order to elucidate the pituitary gonadotropin reserves. Blood plasma and daily urine gonadotropin levels were measured. Changed gonadotropin excretion under the effect of niftolide in health and hypogonadism was in line with changed gonadotropin level in the blood after RF administration, this indicating a similar informative value of both tests for the differential diagnosis of various hypogonadism forms. In the first case measurements of blood gonadotropin were more informative, in the second daily urine analysis. Niftolide test, noninvasive and readily available, is recommended as an alternative test with RF administration.