Resident Report 4/27 -Hypogonadism

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

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