Male hypogonadism is defined as an abnormally low serum testosterone concentration or sperm count. As men age, often in the context of obesity and other comorbid conditions, serum testosterone levels may decrease. Normalizing serum testosterone levels in male adults with hypogonadism may improve symptoms related to androgen deficiency, but controversies exist regarding the long-term benefits and risks of hormone supplementation in this setting. In 2020, the American College of Physicians published a clinical guideline for the use of testosterone supplementation in adult men based on a systematic review of available evidence. Among their recommendations were that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function and not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition. Here, two clinicians with expertise in this area, one a generalist and the other an endocrinologist, debate the management of a patient with sexual symptoms and a low serum testosterone level. They discuss the diagnosis of male hypogonadism, the indications for testosterone therapy, its potential benefits and risks, how it should be monitored, and how long it should be continued.

男性性腺功能减退症被定义为血清睾酮浓度或精子数量异常低。随着男性年龄的增长，通常在肥胖和其他合并症的背景下，血清睾酮水平可能会降低。使患有性腺功能减退症的男性的血清睾酮水平正常化可能会改善与雄激素缺乏相关的症状，但在这种情况下，关于激素补充的长期益处和风险存在争议。2020 年，美国内科医师学会根据对现有证据的系统评价，发布了成年男性使用睾酮补充剂的临床指南。他们的建议包括临床医生讨论是否对年龄相关性低睾酮和性功能障碍的男性进行睾酮治疗，这些男性想要改善性功能，而不是对年龄相关性低睾酮男性进行睾酮治疗以改善能量、活力和身体机能，或认知。在这里，两位在该领域具有专业知识的临床医生，一位是全科医生，另一位是内分泌学家，就对有性症状和血清睾酮水平低的患者的管理进行了辩论。他们讨论了男性性腺功能减退症的诊断、睾酮治疗的适应症、其潜在的益处和风险、应该如何监测以及应该持续多长时间。两位在该领域具有专业知识的临床医生，一位是全科医生，另一位是内分泌学家，就对有性症状和血清睾酮水平低的患者的管理进行了辩论。他们讨论了男性性腺功能减退症的诊断、睾酮治疗的适应症、其潜在的益处和风险、应该如何监测以及应该持续多长时间。两位在该领域具有专业知识的临床医生，一位是全科医生，另一位是内分泌学家，就对有性症状和血清睾酮水平低的患者的管理进行了辩论。他们讨论了男性性腺功能减退症的诊断、睾酮治疗的适应症、其潜在的益处和风险、应该如何监测以及应该持续多长时间。