AB021. What and how should we monitor to diagnose and treat hypogonadism?

Abstract: Male hypogonadism is a clinically and biochemically defined the disease of men with serum testosterone (T) levels below the reference ranges of young man and with symptoms of T deficiency (TD). Morbidity and mortality of TD and the method to treat TD are different by the onset age or reserving fertility. Therefore, diagnostic skills and treatment methods should be set the age, desire (fertility or not) and situation of the patient. The main symptom is sexual dysfunction, anemia, reduced muscle mass and strength, metabolic syndrome, reduction of bone density and lessening of general performance, depressed mood, cardiovascular disease and infertility in young man got married. The diagnosis of hypogonadism is based on the presence of symptoms or signs, TD, and serum T levels. Young adult who need fertility should be treated in to both directions to recover fertility and overcome the low T relating diseases. In the patient who has late onset hypogonadism, we have to target the symptoms and signs, change of body composition and morbidity and mortality. We also have to consider the testosterone replacement therapy (TRT) inducing pathophysiological changes such as polycythemia, blood viscosity, and aggravated benign prostatic hyperplasia (BPH) inducing lower urinary tract symptoms (LUTS) and malignant prostate diseases before and after TRT. I would like to introduce the diagnostic algorithm for the hypogonadal patient before and after TRT. Before TRT for baseline, we have to check anthropometry, CBC, blood chemistry for metabolic syndrome, total T, free T, prostate specific antigen (PSA), transrectal prostate ultrasonography (TRUS), and questionnaires. For the follow-up after TRT, the anthropometry, blood viscosity, in addition CBC, total testosterone, free testosterone, PSA, TRUS, and questionnaires including voiding and erectile status. A semen analysis in the secondary hypogonadal patient who wants fertility has to be considered. I recommend that sample collection for T measurement occur between 7 and 11 a.m. or within 3 h after waking in the shift workers. Measurement of the repeated T and SHBG with calculated free or bioavailable T should be performed to men with TDS and equivocally low T levels when he is needed TRT. For the follow-up, T, PSA, hematocrit, blood viscosity, semen analysis (want baby) and questionnaires should be assessed at 3 and 6 months after onset of TRT and then annually thereafter if stable. A digital rectal examination should be performed at baseline, at 6 months and then annually following onset of TRT. A TRUS should be performed at baseline, at 12 months and then annually following onset of TRT. The interval to recheck has to be differed by the age, duration of the TRT and developing morbidity and mortality. I recommend assessment of response and AE at 3, 6 months after onset of TRT and then annually thereafter.

Keywords: Hypogonadism; testosterone replacement therapy; benign prostatic hyperplasia