Defining Androgen Deficiency

Androgen Deficiency in Men

Historically hypogonadism has been defined as when the effect of sex hormones is inappropriately low for the age of the individual. More recently androgen deficiency has been defined as an absolute or relative insufficiency of testosterone or its metabolites in relation to the needs of that individual at that time of his life.

Regardless of the "favoured" definition for testosterone deficiency the signs and clinical effects of an insufficiency of testosterone in males is uniform.

The consequences of hypogonadism are significant in terms of the shaping of the male persona. They include those of immediate well-being, mood and sexuality and, in the long term, the premature decline of muscular and skeletal strength, together with certain recognisable psychological traits.

The cause of classical androgen deficiency includes:

Testicular disorders

Klinefelter’s syndrome and variants (mosaic)
Cryptorchidism and defects of testis development
Orchitis
Orchidectomy (advanced prostate cancer, bilateral testicular cancer)
Toxin exposure (cancer chemotherapy or radiotherapy, environmental, occupational and domestic toxins)

Hypothalamic-pituitary dysregulation

Idiopathic hypogonadotropic hypogonadism and variants:

  • Kallmann’s syndrome
  • Other genetic causes

Pituitary tumour and treatment (surgery, irradiation)
Haemochromatosis
Craniopharyngioma

Partial or transient androgen deficiency

Constitutional delay of puberty
Acute critical illness, burns, major trauma or surgery
Drug use (eg, opiates, glucocorticoids, anabolic steroids)
Chronic disease and its treatment
Ageing ("late-onset" androgen deficiency, andropause, ADAM)

It is the ADAM male (androgen deficient ageing male) that is the largest under diagnosed group of all testosterone deficient individuals. Symptoms are often non-specific, can be confounded by pre-existing medical conditions (obesity, chronic illness) and include lethargy, sleep disturbances, loss of libido, irritability, reduced concentration and depressed mood.