Male hypogonadism is characterized by low testosterone levels in serum, accompanied by androgen deficiency symptoms, which depend on the time of manifestation. When hypogonadism begins before adolescence, it results in a failure to undergo puberty, whereas postpubertal hypogonadism causes a regression of reproductive function, with impaired libido and impotence, diminished body hair, soft skin, weakness and muscle atrophy, anemia, and osteoporosis. Low testosterone levels, in combination with high gonadotropin levels, indicate a testicular origin (hypergonadotropic or primary hypogonadism), whereas in combination with low gonadotropin levels, the cause is central (hypogonadotropic or secondary hypogonadism) (3). In both primary and secondary hypogonadism, androgen deficiency symptoms can be treated by testosterone substitution (see Chapter 18). In most causes of primary testicular failure, improvement of fertility is not possible, whereas in secondary hypogonadism, fertility may be initiated or restored (see Fig. 1).
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