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Male hypogonadism
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of male hypogonadism are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2025), the European Association of Urology (EAU 2025), the American Academy of Family Physicians (AAFP 2024,2017), the American Urological Association (AUA/SMSNA 2022), the Italian Society of Endocrinology (SIE/SIAMS 2022), the American College of ...
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Screening and diagnosis
Indications for screening, general population: as per EAA 2020 guidelines, do not obtain universal screening for hypogonadism in middle-aged or older males by structured interviews or questionnaires and/or random total testosterone measurements.
D
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Indications for screening (symptomatic patients)
Diagnostic criteria
Diagnostic investigations
Testosterone levels: as per EAU 2025 guidelines, obtain measurement of total testosterone in the morning (7 and 11 AM) and in the fasting state with a reliable laboratory assay for the evaluation of late-onset hypogonadism.
A
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LH/FSH levels
Prolactin levels
Pituitary imaging
Evaluation before testosterone therapy
Medical management
Management of underlying causes, contributing medications: as per EAU 2025 guidelines, assess for concomitant diseases, drugs, and substances possibly interfering with testosterone production/action.
A
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Management of underlying causes (pituitary tumor)
Management of underlying causes (cryptorchidism)
Testosterone therapy (indications for initiation)
Testosterone therapy (indications for avoidance)
Testosterone therapy (contraindications)
Testosterone therapy (choice of preparation)
Testosterone therapy (goals of treatment)
PDE5 inhibitors
Nonpharmacologic interventions
Specific circumstances
Patients with hypogonadotropic hypogonadism: as per EAU 2025 guidelines, initiate combined hCG and FSH (recombinant FSH, highly purified FSH) or pulsed GnRH via pump therapy to stimulate spermatogenesis in patients with hypogonadotropic hypogonadism (secondary hypogonadism), including congenital causes.
A
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Patients with delayed ejaculation
Patient education
General counseling
As per EAU 2025 guidelines:
Inform patients fully about the expected benefits and adverse effects of any treatment option. Select the testosterone preparation in a joint decision process, only with fully informed patients.
A
Provide full counseling in patients with symptomatic hypogonadism previously surgically treated for localized prostate cancer (currently not showing evidence of active disease) and considering testosterone therapy, emphasizing the benefits and lack of sufficient safety data on long-term follow-up.
B
Follow-up and surveillance
Indications for specialist referral: as per ES 2018 guidelines, refer patients with hypogonadism to a urologist in case of a confirmed increase in PSA concentration > 1.4 ng/mL above baseline or confirmed PSA > 4.0 ng/mL, or a prostatic abnormality detected on DRE during the first 12 months of testosterone therapy.
B
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Clinical and laboratory follow-up