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:
- functional/impact from other conditions (with potential for reversibility)
- androgen steroid abuse or recovery
- intercurrent illness
- medications (e.g. opiates)
- obesity
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
- Malignancy:
- germ cell tumours
- testicular tumours
- Primary testicular failure:
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
