Endocrine Abstracts

Introduction: Male hypogonadism is a clinical syndrome comprising symptoms, signs and biochemical evidence of testosterone deficiency due to primary testicular failure or secondary pituitary/hypothalamic disease. Management may vary. This audit aimed to assess adherence to Endocrine Society Clinical Practice guidelines in investigation and management of male hypogonadism.

Methods: Electronic patient records for 25 men with hypogonadism attending endocrinology over 1 month were retrospectively reviewed. Baseline, repeat testosterone levels, gonadotrophins and DEXA scans where available were recorded, as well as serum prolactin, pituitary hormones, ferritin and pituitary MRI in secondary hypogonadism cases.

Results: 25 out of 76 men (33%) attending endocrinology were referred with hypogonadism. Average age was 47 years. Average baseline total testosterone was 7.8 nmol/l. 12 (48%) were morning samples. 23 (92%) had repeat testosterone measured, however only 9 (36%) were morning samples. All had gonadotrophins measured. 11 (44%) underwent DEXA imaging. Out of 15 men with secondary hypogonadism, 14 (93%) had prolactin measured, 15 (100%) had TSH/free T₄ measured, 11 (73%) had IGF1 measured, 12 (80%) had serum cortisol/short synacthen test, 5 (33%) had ACTH, and 10 (67%) had ferritin measured. 12 (80%) had a MRI pituitary scan. 14 out of 19 men with confirmed hypogonadism (74%) commenced testosterone replacement. Average total testosterone level pre-treatment was 5.2 nmol/l, post-treatment 13.5 nmol/l. 13 (93%) on testosterone replacement had PSA and haematocrit measured. 11 (79%) reported symptom improvement, 2 (14%) had side effects, 2 (14%) stopped.

Conclusion: The majority of baseline testosterone levels merited endocrinology referral. Investigations and treatment were broadly in line with recommendations. Due to logistical reasons, the majority of repeat testosterone samples were afternoon samples. This may present diagnostic challenges due to the diurnal nature of serum testosterone. Due to increased osteoporosis risk, greater use of DEXA imaging may also be useful. These areas should be addressed in future practice.