Expert Opinion on the Diagnosis and Management of Male Hypogonadism in India

Abstract

Male hypogonadism (MH) is a clinical and biochemical syndrome caused by inadequate synthesis of testosterone. Untreated MH can result in long-term effects, including metabolic, musculoskeletal, mood-related, and reproductive dysfunction. Among Indian men above 40 years of age, the prevalence of MH is 20%–29%. Among men with type 2 diabetes mellitus, 20.7% are found to have hypogonadism. However, due to suboptimal patient-physician communication, MH remains heavily underdiagnosed. For patients with confirmed hypogonadism (either primary or secondary testicular failure), testosterone replacement therapy (TRT) is recommended. Although various formulations exist, optimal TRT remains a considerable challenge as patients often need individually tailored therapeutic strategies. Other challenges include the absence of standardized guidelines on MH for the Indian population, inadequate physician education on MH diagnosis and referral to endocrinologists, and a lack of patient awareness of the long-term effects of MH in relation to comorbidities. Five nationwide advisory board meetings were convened to garner expert opinions on diagnosis, investigations, and available treatment options for MH, as well as the need for a person-centered approach. Experts’ opinions have been formulated into a consensus document with the aim of improving the screening, diagnosis, and therapy of men living with hypogonadism.

TRT – The Best Treatment for Balancing Testosterone in Middle Aged Men

“…pooled analysis of other observational studies in obese hypogonadal men with T2DM found that testosterone replacement therapy (TRT) significantly reduced-i) fasting blood glucose and HbA1c levels, ii) total cholesterol, iii) low-density lipoprotein cholesterol, iv) triglycerides, thus reducing the risk of CVD, v) levels of inflammatory markers suggesting reduction in the inflammation response, vi) increased high-density lipoprotein cholesterol levels, vii) improved systolic and diastolic blood pressure. These data were validated in a placebo-controlled study over 2 years published in January 2021 [8,9].…”

“…The Endocrine Society of India (ESI) recommends TTh for men who have either less than 300 ng/dL of testosterone in the blood or symptoms of low testosterone. Measurement of serum FT and/or bioavailable testosterone is considered necessary in individuals suspected of having any disorder accompanied by increased or decreased sex hormone binding globulin (SHBG) levels [8].…”

“…Testosterone is frequently used for the optimization of mid-life health. For patients with confirmed hypogonadism (either primary or secondary), TRT is recommended [8]. Testosterone injections as hormone replacement treatments are given for sexual dysfunction in males.…”

“…The optimal indication for TRT in LOH is the presence of signs and symptoms of hypogonadism and low-T without contraindications for TRT. LOH is the result of a gradual drop in T levels of about 1% per year, is well documented in men [8], and varies between individuals, with higher rates of decline in men with adiposity and comorbid diseases like diabetes. In LOH, the anabolic effect of T is reduced due to its deficiency [11,12] ( Although various formulations exist, optimal TRT remains a considerable challenge as patients often need individually tailored therapeutic strategies.…”