The hypothalamus secretes gonadotropin-releasing hormone (GnRH) that acts on the anterior pituitary to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The regulation of testosterone production in eugonadal men depends on the HPG axis depicted in Figure 1. The different names have arisen as authors try to separate the hypogonadism resulting from natural ageing from, for example, the hypogonadism caused by testicular trauma. There is a high prevalence of hypogonadism in the middle- and older-aged male population and various prevalence figures have been described in a number of studies. These are applied in the night and provide a good approximation of normal circadian plasma testosterone levels. Some patients show parallel variations in breast tenderness, sexual activity, emotional stability (anger or depression) and general well-being (fatigue) as the testosterone levels change over time. A characteristic of injected testosterone esters is that, after the injection, the serum testosterone levels rise to supraphysiological levels, after which they gradually decline into the hypogonadal range by the end of the dosing interval. In secondary hypogonadism, prolactin levels should be obtained to rule out prolactinoma and screening for hemochromatosis should be considered. The final step in determining whether a patient has primary or secondary hypogonadism is measuring the serum LH and FSH. Because of the increase in sex hormone–binding globulin (SHBG) with aging, total testosterone level is a less sensitive indicator of hypogonadism after age 50. Some syndromes of hypogonadism (eg, cryptorchidism, some systemic disorders) affect sperm production more than testosterone levels. When primary hypogonadism affects testosterone production, testosterone is insufficient to inhibit production of FSH and LH; hence, FSH and LH levels are elevated. It may result from a disorder of the testes (primary hypogonadism) or of the hypothalamic-pituitary axis (secondary hypogonadism). Endocrinologists diagnose the condition using hormone tests and imaging and treat it with testosterone therapy, lifestyle changes, and fertility-preserving methods. Treatment aims to bring testosterone back to normal levels, reduce symptoms, and improve overall quality of life. Approximately 20–50% of HIV-infected men receiving highly active antiretroviral therapy are hypogonadal. In a case–control study of 40 cancer survivors it was found that 90% of those on opioid treatment were hypogonadal compared with only 40% of the control group (69). Various epidemiological studies in men have examined associations between testosterone and estradiol levels and BMD. There is an inverse linear relationship between total testosterone and BMI, and free testosterone concentrations also decrease with increasing BMI. Utilising data from the NHANES III survey, it was found that men in the lowest free testosterone tertile were four times as likely to have diabetes as those in the highest free testosterone tertile (47). Interestingly, low testosterone concentrations predict the development of type 2 diabetes. The concentrations of C-reactive protein in these patients are twice as high as those in eugonadal type 2 diabetics, whose C-reactive protein levels are already elevated compared with non-diabetics. The mechanism for OPIAD is thought to involve suppression of GnRH release by the hypothalamus, thereby inducing secondary hypogonadism (17,70). There have been some studies that suggest that COPD patients have a higher incidence of hypogonadism than the general population and that glucocorticoid treatment is only part of the reason. Adipose tissue affects testosterone levels by increasing the aromatisation of testosterone to estradiol, because the aromatase enzyme is concentrated in adipocytes. Dr. Tashko also treats low testosterone (TRT), gynecomastia, and polycystic ovary syndrome (PCOS). He specializes in diabetes, metabolism, and longevity care, offering integrative, evidence-based solutions for insulin resistance, metabolic syndrome, prediabetes, obesity, and weight management. Medications like dopamine agonists can reduce prolactin levels in cases of prolactinoma. It can relieve symptoms like low energy, weak muscles, and low libido. A personalized treatment plan is important to meet each patient’s needs.
.png "Đăng ký tên miền")
