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Paediatric and adult-onset male hypogonadism

Nature Reviews Disease Primers volume 5, Article number: 38 (2019) Cite this article

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Abstract

The hypothalamic–pituitary–gonadal axis is of relevance in many processes related to the development, maturation and ageing of the male. Through this axis, a cascade of coordinated activities is carried out leading to sustained testicular endocrine function, with gonadal testosterone production, as well as exocrine function, with spermatogenesis. Conditions impairing the hypothalamic–pituitary–gonadal axis during paediatric or pubertal life may result in delayed puberty. Late-onset hypogonadism is a clinical condition in the ageing male combining low concentrations of circulating testosterone and specific symptoms associated with impaired hormone production. Testosterone therapy for congenital forms of hypogonadism must be lifelong, whereas testosterone treatment of late-onset hypogonadism remains a matter of debate because of unclear indications for replacement, uncertain efficacy and potential risks. This Primer focuses on a reappraisal of the physiological role of testosterone, with emphasis on the critical interpretation of the hypogonadal conditions throughout the lifespan of the male individual, with the exception of hypogonadal states resulting from congenital disorders of sex development.

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Fig. 1: The hypothalamic–pituitary–gonadal axis.
Fig. 2: Anatomical changes and serum hormone levels associated with male sex determination and maturation.
Fig. 3: Pathophysiology of hypogonadism.
Fig. 4: Pathophysiology of congenital secondary hypogonadism.
Fig. 5: Relationship between age, BMI and reproductive hormones.
Fig. 6: Diagnostic algorithm for hypogonadism in pubertal age.

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Author information

Authors and Affiliations

  1. Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Andrea Salonia

  2. Università Vita-Salute San Raffaele, Milan, Italy

    Andrea Salonia

  3. Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy

    Giulia Rastrelli, Giovanni Corona & Mario Maggi

  4. Department of Urology, University of Bedfordshire, Bedfordshire, UK

    Geoffrey Hackett

  5. Harvard Reproductive Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Stephanie B. Seminara

  6. Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK

    Ilpo T. Huhtaniemi

  7. Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland

    Ilpo T. Huhtaniemi

  8. Centro de Investigaciones Endocrinológicas ‘Dr César Bergadá’ (CEDIE), CONICET — FEI — División de Endocrinología, Hospital de Niños R. Gutiérrez, Buenos Aires, Argentina

    Rodolfo A. Rey

  9. Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA

    Wayne J. G. Hellstrom

  10. Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada

    Mark R. Palmert

  11. Departments of Paediatrics and Physiology, University of Toronto, Toronto, Ontario, Canada

    Mark R. Palmert

  12. Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy

    Giovanni Corona

  13. Department of Urology, Erasmus University Medical Centre, Rotterdam, Netherlands

    Gert R. Dohle

  14. Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

    Mohit Khera

  15. Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA

    Yee-Ming Chan

  16. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Yee-Ming Chan

  17. Istituto Nazionale Biostrutture e Biosistemi (INBB), Rome, Italy

    Mario Maggi

Authors
  1. Andrea Salonia
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  2. Giulia Rastrelli
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  3. Geoffrey Hackett
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  4. Stephanie B. Seminara
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  5. Ilpo T. Huhtaniemi
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  7. Wayne J. G. Hellstrom
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  8. Mark R. Palmert
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  9. Giovanni Corona
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  10. Gert R. Dohle
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  13. Mario Maggi
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Contributions

Introduction (A.S.); Epidemiology (G.R. and G.H.); Mechanisms/pathophysiology (S.B.S. and I.T.H.); Diagnosis, screening and prevention (R.A.R. and W.J.G.H.); Management (M.R.P., G.C. and G.R.D.); Quality of life (M.K.); Outlook (Y.-M.C. and M.M.); Overview of Primer (A.S.).

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Correspondence to Andrea Salonia.

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Salonia, A., Rastrelli, G., Hackett, G. et al. Paediatric and adult-onset male hypogonadism. Nat Rev Dis Primers 5, 38 (2019). https://doi.org/10.1038/s41572-019-0087-y

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  • DOI: https://doi.org/10.1038/s41572-019-0087-y

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