The following factual responses are sourced from the American Association of Clinical Endocrinologists Hypogonadism Guidelines, 2002 Update

1. - What is Hypogonadism?
A. Hypogonadism is the failure of the body to produce sufficient Testosterone to meet the body's needs. This has the effects of throwing the delicate balance of the overall system out.

2. - Can I "catch" Hypogonadism
A.To coin a phrase, it depends what "catch" means. Some people are born with it, due to a genetic problem, others acquire it as they go through life through, amongst others, illness, environmental effects, alcohol intake, smoking, drugs, (prescribed or otherwise), or injury.
In the case of women, it occurs mostly post-menaupause when the ovaries cease to function in an effective manner. Ovarian failure pre-menaupause, however, is just as prevalent as testicular failure.

3. Are there "varieties" of Hypogonadism.
A. Yes, there are three definitions used by doctors. They are "Primary", "Secondary" and "Central". Primary Hypogonadism refers to Testicular/Ovarian failure.
Secondary Hypogonadism refers to a problem in the Pituitary gland or HTPA (The Hypothalmic-Pituitary Axis).
Central Hypogonadism refers to problems in both Testicles and Pituitary.
It is important to distinguish which one applies when considering treatments.

4. - What are the effects of Hypogonadism
A.All are negative. So-called "Mild" Hypogonadism tends to result in lethargy, low libido and general malaise. As the individual slides down the "Hypogonadism" ladder, depression, mood swings, hot flashes and sometimes suicidal thoughts tend to become a feature. Full blown Hypogonadism can result in many diseases including Osteoporosis, Alzheimers, Diabetes, Arthritis and/or Cardio-vascular problems.

5. What tests do I need to get done?
A. At this stage, The advice by the American association of Clinical Endocrinologists is to get Serum Testosterone, LH, FSH and Prolactin measured. SHBG, or Free Testosterone by equilibrium dialysis is also desirable. Any doctor can order these tests.

6 - Is Testosterone therapy the only answer to Hypogonadism?
A. It depends on whether the Hypogonadism is Primary or Secondary. If it is secondary, there is a possibility that a pre-cursive hormone such as HCG (Human Chorionic Gonadotropin) would stimulate the body to produce it's own Testosterone. That avenue should be explored before looking at Testosterone therapy.
Primary Hypogonadism will always attract Testosterone therapy. Central Hypogonadism is inevitably resolved with Testosterone therapy.

7- Why does my doctor say my tests are "normal" yet I still feel like a shadow of my former self?
A. If you have symptoms of low Testosterone, it may be that
a: Your Testosterone Levels are ok and something else is wrong,
or
b: Your doctor may not be aware that traditional testing methods are unreliable. In either case, careful investigation remains the answer by adopting the American Assn of Clinical Endocrinologists Hypogonadism guidelines as your guide and pursuing your symptoms to their logical conclusion with your GP.

8- My doctor says my results are "low-normal" but ok. The suggestion is I am depressed. Are anti-depressants the answer?
A. The AACE makes it clear that "low-normal" results does not mean all is well. Other tests are necessary to establish the cause of such readings and correct treatment for symptoms applied, before reaching for anti-depressants.

9- Why is it that my doctor doesn't know this stuff?
A. This problem has remained hidden to doctors as well as the public. The release of the AACE guidelines in December 2002 is a radical departure from the standards and will take time to permeate through to GP level. As more doctors become aware of the problem and increasing numbers of patients armed with the new guidelines to help their doctor visit surgeries, so interest and information will become current and uniform.

10- My doctor says Testosterone therapy is dangerous to my health.

A.Your doctor is right, if it is taken in overdose proportions. Until ten years ago, that is all we could take. However, new daily therapies exist which do not produce such situations. Care needs to be taken, if therapy is undertaken, to make sure overdoses do not occur and other hormones and indicators should be measured in follow-up, according to the AACE.

Opinion

THE PROBLEM For many years, doctors have been unable to recognise the symptoms of low Testosterone. A combination of inadequate research, confusing procedures and a certain amount of denial, has conspired to leave Testosterone in the deep recesses of the unknown. In order to better understand Testosterone, much more research needs to be carried out with larger numbers However, as the detection of low Testosterone is historically flawed, finding subjects in sufficient quantities is not very easy. With the advent of new very sensitive testing procedures, doctors will be able to test and treat accurately and the numbers of people on TRT will increase over time. But, what of those who languish with untreated symptoms? Specialists in the diseases indicated with hypogonadism as a significant factor, need to become pro-active in testing patients and educating student doctors with a slightly modified diagnostic structure, to include Hypogonadism testing as routine.

CONCLUSION If new practices as outlined by the AACE are to achieve the desired result in the shortest space of time, there appears to be a need to educate the public and General Practitioners.
Very often, in the course of my work, it is the partner who, in desperation, identifies the problem and relates symptoms, normally "psychological" via email. Correct testing ivariably results in TRT.
I conclude that the sooner the symptoms are recognised for what they may be and new testing procedures are followed, the faster research into testosterone will progress.
It is further concluded that it is unsafe practice for a GP to omit TRT testing when presented with "psychological" symptoms by either partner in a relationship and prescribe anti-depressants.

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