DIAGNÓSTICO Y MANEJO DEL HIPOGONADISMO MASCULINO.

El hipogonadismo masculino se caracteriza por disfuncion testicular y/o del eje hipotalamo-hipofisario produciendo una reduccion de las concentraciones de testosterona. Se clasifica en hipogonadismo hipogonadotropico (Hh) e hipogonadismo hipergonadotropico (HH), y a su vez en causas adquiridas y congenitas. Las gonadotropinas pueden estar elevadas (HH) o disminuidas (Hh) y en general cursan con niveles disminuidos de testosterona. Dentro de las pruebas que apoyan al diagnostico y manejo se incluyen el ecosonograma testicular, evaluacion genetica, densitometria osea, biopsia testicular, estudios imagenologicos, espermograma, anticuerpos antiespermaticos y las pruebas dinamicas. Por ultimo, la terapia de reemplazo con testosterona es el principal tratamiento, y la meta es obtener valores de testosterona total entre 400 y 700 ng/dL. A continuacion, se presenta el protocolo para el diagnostico y manejo del hipogonadismo masculino, con la evidencia cientifica y la experiencia clinica de la Unidad de Endocrinologia del IAHULA.(AU) Male hypogonadism is characterized by testicular dysfunction secondary to testicular damage and/or hypothalamus-pituitary axis dysfunction resulting in a reduction in testosterone levels. It is classified as hypogonadotropic hypogonadism (Hh) or hypergonadotropic hypogonadism (HH), and these are also divided in acquired and congenital causes. Gonadotropins may be high (HH) or decreased (Hh) and generally occur with decreased testosterone levels. Among the tests supporting the diagnosis and management are included testicular ultrasonography, genetic screening, bone densitometry, testicular biopsy, imaging studies, spermogram, sperm antibodies and hormonal dynamic tests. Finally, testosterone replacement therapy is the main treatment, and the goal is to obtain total testosterone values between 400 and 700 ng/dL. Below, is presented the IAHULA Endocrinology Unit guidelines for male hypogonadism management, based on scientific evidence and clinical experience.(AU)