There is a high prevalence of hypogonadism in the middle- and older-aged male population and various prevalence figures have been described in a number of studies. These risks, however, are often exaggerated and should not outweigh the benefits of testosterone treatment. There are a number of formulations available for testosterone therapy including intramuscular injections, transdermal patches, transdermal gels, buccal patches and subcutaneous pellets. 2.6 In men with type 2 diabetes mellitus who have low testosterone concentrations, we recommendagainst testosterone therapy as a means of improving glycemic control. 2.5 We suggest that clinicians consider short-term testosterone therapy in HIV-infected men with low testosterone concentrations and weight loss (when other causes of weight loss have been excluded)to induce and maintain body weight and lean mass gain. In patients with primary hypogonadism, history might reveal the cause for primary testicular failure, such as familial autoimmune disease, physical trauma to the testes, or trauma to the testes caused by radiation, chemotherapy, or infection. If the FSH and LH levels are raised, this suggests a primary testicular cause, and if levels are low or normal, a hypothalamic or pituitary cause should be considered. In the prepubertal age group, hypogonadism might be either primary hypogonadism or secondary hypogonadism. Another intriguing observation is that prostate-specific antigen (PSA), a marker for prostate cancer, is significantly lower in type 2 diabetics and this is related to their lower plasma testosterone concentrations (46). This is in contrast to what was found in the MMAS study where total testosterone levels were unrelated to all-cause mortality (34,35). In fact, epidemiological analyses have found that HDL levels are positively linked to testosterone levels in middle-aged men. The Massachusetts Male Ageing Study (MMAS) measured a combination of testosterone levels and hypogonadal symptoms and found between 6% and 12% of men had symptomatic androgen deficiency (21). Over time, low testosterone may cause a man to lose body hair, muscle bulk, cause weak bones (osteoporosis), low red blood cells and smaller testes. The brain and pituitary gland (a small gland at the base of the brain) control the production of testosterone by the testes. It is estimated that approximately 35% of men older than 45 years of age and 30-50% of men with obesity or type 2 diabetes have hypogonadism. With the total testosterone and SHBG levels, a bioavailable testosterone value can be calculated. In elderly men, testosterone levels decrease between 15% and 20% over the course of 24 hours.8 We strongly advise that you ask men with MH about new urinary symptoms within the first few months following testosterone treatment initiation and refer for urological assessment appropriately.
