Updates in male hypogonadism: what is functional hypogonadism and how should it be managed?

[madman]

Dr Channa Jayasena

Functional hypogonadism - what is it?

SUMMARY: Men with functional. hypogonadism

Conclusion - before considering TRT

Conclusions if initiating TRT

 

[madman]

Male Hypogonadism - overview

 

[madman]

Testosterone prescription rates in the UK have been rising

 

[madman]

Classification of male hypogonadism

 

[madman]

* the first line and testosterone is the only treatment




Organic hypogonadism in men

 

[madman]

* there is theoretically a chance; there is no structural irreversibility to the condition




Low T in man with functional hypogonadism

 

[madman]

Functional hypogonadism - How is it diagnosed?

Need morning + fasted testosterone

25% reduction in T following glucose load

 

[madman]

* around 2% of the testosterone in the blood is free testosterone




Testosterone in the blood

* <220 picomoles is a cutoff

Calculate free T when total T is borderline low, or SHBG is altered

Free & Bioavailable Testosterone calculator

 

[madman]

* In other words there's a poor discrimination. You could be well or hypogonadal in this range and that's what I call the ZONE OF UNCERTAINTY.




Sliding scale of bio-chemical evidence

 

[madman]

Does T make functional. hypogonadal men feel better?

Does testosterone improve sexual symptoms, mood, and QOL in men with hypogonadism?

 

[madman]

Identifying subgroups of men experiencing symptomatic benefits during testosterone treatment: results of individual patient and aggregate data meta-analysis

Improvements in quality of life, sexual function but limited psychological benefits

AMS Scores

 

[madman]

NIH T Trial: Sexual Function

NIH T Trial: Safety results

 

[madman]

TRAVERSE Sexual Function Substudy:

TRAVERSE: Overview of safety

TRAVERSE Sexual Function Subsidy - results

 

[madman]

TRT was associated with small improvements in mood and energy in hypogonadal men with and without depressive symptoms compared with placebo

 

[madman]

What about lifestyle intervention?

Lifestyle intervention

 

[madman]

* health optimization is first-line




Does testosterone improve sexual symptoms, mood, and QOL in men with functional hypogonadism?

 

[madman]

Summary: Men with functional hypogonadism

 

[madman]

Conclusion - before considering TRT

Conclusion if initiating TRT

 

[madman]

Thread 'Importance of free testosterone measurement in assesssing androgen disorders'

Jun 15, 2025

As usual Nelson's house is where it's at!

Importance of free testosterone measurement in assessing androgen disorders

Thursday, March 27, 2025 at 1:00 PM Eastern Daylight Time.

event.on24.com

Testosterone imbalances affect men, women, and children differently. In males, testosterone deficiency (hypogonadism) can lead to low libido, fatigue, and muscle loss, while excess may contribute to aggression and cardiovascular risks. In females, testosterone excess (hyperandrogenism), often associated with polycystic ovary syndrome (PCOS) or adrenal disorders, can cause excess hair growth, weight gain, and menstrual irregularities. In children...

• madman
• hypogonadism; free t; accuracy assays/diagnosis
• Replies: 24
• Forum: Testosterone and Men's Health Articles

 

[madman]

Thread 'SHOULD FUNCTINAL HYPOGONADISM BE TREATED?'

Sep 29, 2025

I say Dr. Zitmann for the win!

Take home message

• madman
• hypogonadism; testosterone therapy; health
• Replies: 14
• Forum: Testosterone and Men's Health Articles