GuidelinesEML (Adult Hospital STG)
Androgen Deficiency
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
ICD-10 Code: E29.1
DESCRIPTION
Reduced testosterone due to hypothalamic/pituitary hypofunction or primary testicular failure.
Investigations
- Morning (08h00–09h00) serum total testosterone.
- LH and FSH.
| Serum testosterone | LH and FSH | |
| Primary testicular failure | Below normal | Above normal |
| Secondary (hypothalamic/ pituitary) hypogonadism | Below normal | Normal or below normal |
Note
If the serum total testosterone concentration is borderline low repeat the test before replacement therapy is initiated. Don’t test during serious illness
- Measure serum prolactin
- Sperm count, if infertility is a consideration.
- Further investigations to determine cause to be undertaken after referral; consult a specialist
MEDICINE TREATMENT
Screen hypogonadal men for prostate cancer before beginning testosterone replacement.
- Testosterone therapy can induce prostatic hypertrophy, polycythaemia, liver dysfunction, sleep apnoea and hyperlipidaemia.
- Baseline investigations for these are required prior to initiation of therapy and long-term surveillance is required.
- Individualise dosage and review doses based on clinical response.
- Testosterone cypionate, deep IM, 200-300 mg every 2-4 weeks.
- Monitor patients for prostate cancer during treatment.
- Monitor haematocrit. If haematocrit >54%, stop testosterone therapy.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition