Clinical Manifestation and Diagnosis of Androgen Deficiency

Male hypogonadism is defined as a clinical syndrome resulting from failure of the testes to produce physiological levels of testosterone and normal number of spermatozoa, due to disruption of one or more levels of the hypothalamic-pituitary-testicular axis. The clinical and biochemical features of male hypogonadism vary according to the period of life when the gonadal failure begins and the level at which the disruption of hypothalamic-pituitary-testicular axis occurs. Whereas the fetal and prepubertal onset of androgen deficiency typically do not pose diagnostic difficulties, the identification of so-called adult- or late onset hypogonadism remains challenging. Low specificity of symptoms that are further confounded by comorbidities and aging, as well as relative inaccuracy of the assays deployed to measure testosterone level are the major factors hampering the precise diagnosis in ageing male without classical hypothalamic-pituitary-gonadal axis pathology.