ABSTRACT

Hypogonadism is a multisystem syndrome associated with impaired androgen production or action. Use of recreational drugs such as alcohol, marijuana, opiates, and cocaine can be associated with hypogonadotropic hypogonadism. Many antipsychotic and antidepressant drugs are associated with hyperprolactinemia that can cause hypogonadotropic hypogonadism. In men with congenital hypogonadotropic hypogonadism, testicular volume is a good marker of the degree of gonadotropin deficiency and the likelihood of response to therapy. Inactivating mutations of the luteinizing hormone (LH) receptor gene are associated with hypogonadism and Leydig cell hypoplasia. Pharmacological doses of glucocorticoids inhibit LH and follicle-stimulating hormone secretion by multiple mechanisms and directly inhibit testicular synthesis of testosterone. The benefits of testosterone replacement therapy have only been demonstrated in men who have androgen deficiency, as indicated by serum testosterone levels that are distinctly below the lower limit of the normal male range. Some hypogonadal men continue to complain of sexual dysfunction even after testosterone replacement has been instituted.