Curriculum standards
Knowledge guides
LG 23: Male reproductive endocrinology
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management, and integrate these into care.
Presentations
- Delayed/incomplete puberty
- Erectile dysfunction
- Gynaecomastia
- Infertility
- Lack/loss of virilisation
- Loss of libido
- Low bone density and/or fractures
- Vasomotor symptoms
Conditions
- Primary testicular failure
- chemotherapy
- cryptorchidism
- genetic conditions
- congenital anorchia
- Klinefelter syndrome
- infection
- radiation
- surgical
- Hypogonadotropic hypogonadism
- structural:
- autoimmune endocrinopathies
- immunotherapy -related hypophysis (IRAEs)
- infiltrative disorders:
- histiocytosis (Langerhans)
- iron overload syndromes
- lymphocytic hypophysis
- sarcoidosis
- isolated GnRH deficiency
- pituitary or hypothalamic:
- radiation
- trauma
- tumours
- functional/impact from other conditions (with potential for reversibility)
- androgen steroid abuse or recovery
- intercurrent illness
- medications (e.g. opiates)
- obesity
- structural:
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Congenital adrenal disorders
- Hypogonadotropic hypogonadism:
- developmental defects and genetic syndromes
- infiltrative disorders:
- iron overload syndromes
- lymphoma
- Kallman syndrome
- Infertility:
- azoospermia/oligospermia:
- non-obstructive
- obstructive versus
- fertility preservation prior to chemoradiation
- azoospermia/oligospermia:
- Malignancy:
- germ cell tumours
- testicular tumours
- Primary testicular failure:
- myotonic dystrophy
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Diagnostic work up
- Aetiology, pathology, and clinical manifestations of hypogonadism
- Impact of environmental, psychological, and comorbid conditions on the HPT axis
- determine when hormonal replacement is and when it is not indicated
- Thorough history, physical examination and diagnostic work up of men presenting with hypogonadism and/or infertility
Treatment
- Androgen deprivation therapy (e.g., treatment of prostate cancer)
-
Approach to treatment according to fertility aspirations
- indications, contraindications and appropriate prescribing of testosterone replacement therapy, understanding that this is lifelong therapy
- monitoring of testosterone therapy and its’ potential complications with dose adjustment as needed
- utilisation of gonadotrophin therapy for spermatogenesis induction when indicated
-
Preventative screening as needed:
- bone health
- cardiovascular
- prostate
-
Androgenic steroid use and abuse
- drug types and regimens
- suppression and recovery of the HPT axis
- side effects, both short- and long-term
- strategies to deal with cessation and mental health challenges
Clinical assessment tools
- Appropriate testicular examination including use of orchidometer
Investigations
-
Karyotype:
- Y chromosome microdeletion analysis when indicated
-
Laboratory biochemistry:
- specific understanding of the timing, patient preparation and assay platforms suited for sex steroid analysis
-
Radiology:
- bone mineral density
- MRI
- ultrasound
- Semen analysis
Procedures
- Referrals for:
- assisted reproduction services
- fertility preservation, when appropriate
- microscopic testicular sperm extraction to experienced specialist surgeon
Evidence-based practice
- Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients
General management considerations
- Cardiovascular risk mitigation
- Impact of sexual dysfunction, infertility and/or genetic diagnoses on the patient, their partner and, where applicable, their family and carers:
- consider the sociocultural impact of infertility
- Impact of socioeconomic factors on equitable access to fertility preservation and treatment services
- Incorporate environmentally sustainable practices in clinical care
- Interaction of androgen deficiency as a potential cause and consequence of mental health disorders
- Side effects of testosterone therapy
- Symptom management
- Referrals and access to genetic, sexual, and relationship counselling
Health needs of specific patient groups
- Ethical considerations in discussing fertility preservation procedures with adolescents and their family
- Longitudinal care of men with genetic conditions such as Klinefelter syndrome:
- cardiovascular risk screening and mitigation
- collaboration with:
- counselling services
- education services
- primary care providers
- Screening in cancer survivorship