Teaching Pearls:

• Clinical manifestations include low energy, low libido, erectile dysfunction, hot flashes, etc
• Primary hypogonadism in males
  • Low total testosterone levels and elevated LH and FSH
• Secondary hypogonadism
  • Low total testosterone levels and normal to low LH and FSH levels
• In males, elevated prolactin levels lead to decreased production of LH and FSH
  • Decreased LH leads to decreased testosterone production from Leydig cells
  • Decreased FSH leads to decreased spermatogenesis from seminiferous tubules
• Elevated prolactin levels could result from medication use
  • Dopamine is secreted by the hypothalamus and leads to inhibition of prolactin secretion
  • Antipsychotic medications exert its effect by blocking dopamine receptors on lactotrophs, leading to increased prolactin secretion.
• Work-up:
  • Check TSH, total and free testosterone, FSH and LH, and prolactin level