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Prof Subhankar Chowdhury, Kolkata 21 November 2018

Diagnosis of male hypogonadism is made by testing early morning fasting testosterone by reliable assay in appropriate clinical setting.
Treatment options depend on etiology (primary/secondary); fertility concern; age of patient and safety issues.
It is important to treat the primary/underlying cause.
Primary hypogonadism requires testosterone therapy. Fertility options include TESE and ICSI, donor sperm and adoption.
In secondary hypogonadism, gonadotropin therapy improves fertility.
Testosterone therapy monitoring – Target testosterone: Mid-normal range for healthy young males; Serum testosterone and packed cell volume (PCV): 3-6 months post-initiation, then yearly; PCV >54% - stop therapy, till it decreases to <50%, evaluate for hypoxia and sleep apnea and reinitiate with a reduced dose; PSA: 3-12 months post-initiation if age >40 years. Δ PSA >1.4 ng/mL or absolute value >4 ng/mL warrants urology referral.
Pubertal induction in boys with isolated hypogonadotropic hypogonadism (IHH) – Injection testosterone monthly; start with low dose, with 6-monthly increments; Reach adult dose over 3-4 years; Adult dose – 200 mg/2 weekly or 100 mg/week.
Testosterone replacement in hypogonadal males: Benefits >>> risks.

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