Treatment of Male Hypogonadism: Patient Information

Understanding Hypogonadism

Hypogonadism is a clinical condition in which the testes produce insufficient testosterone, the primary male sex hormone. This can be due to issues with the testes themselves (primary hypogonadism) or problems with the hypothalamus or pituitary gland (secondary hypogonadism).

Common Symptoms of Low Testosterone

If you are experiencing any of the following symptoms, you may be experiencing low testosterone:

  • Persistent fatigue or low energy

  • Low libido (sex drive)

  • Erectile dysfunction

  • Decreased muscle mass or strength

  • Increased body fat, especially abdominal

  • Mood changes, including low mood or irritability

  • Poor concentration or memory

  • Sleep disturbances

  • Infertility

  • Reduced shaving frequency or body hair

These symptoms should be investigated in context and confirmed through appropriate testing.

The Investigation Process

Before treatment can be considered, a structured and thorough medical work-up is required, consistent with the Andrology Australia and TGA prescribing guidelines:

1. Detailed Medical History and Physical Examination

  • Assessment of symptoms and contributing factors (e.g., obesity, medications, stress, sleep apnoea)

  • Evaluation of testicular development, body composition, and secondary sexual characteristics

2. Blood Tests

To confirm a diagnosis, blood tests are taken:

  • Two early morning total testosterone levels (usually before 10am) on separate days (Levels <8nmol/L indicate hypogonadism)

  • Sex hormone binding globulin (SHBG)

  • Luteinising hormone (LH) and follicle-stimulating hormone (FSH)

  • Prolactin (if indicated)

  • Estradiol, full blood count, PSA (prostate screen), and metabolic panel

Testosterone should not be measured during acute illness or following heavy alcohol use or sleep deprivation.

A diagnosis of pathological hypogonadism is confirmed when:

  • Symptoms are present and

  • Two separate testosterone levels are consistently below the normal reference range(<8nmol/L)

When treatment is appropriate (According to Andrology Australia)

Treatment may be considered when both of the following are present:

  1. Clinical features of hypogonadism, and

  2. Biochemical evidence of androgen deficiency

Treatment is not approved for:

  • Normal ageing

  • Non-specific fatigue or low libido without confirmed testosterone deficiency

  • Bodybuilding or enhancement of athletic performance

Specialist Referral Requirements

Under TGA Schedule 4 (S4) and SAS-B or AP frameworks, prescribing for certain patients may require:

  • Referral to or review by an endocrinologist or urologist, especially in cases of:

    • Fertility concerns

    • Elevated PSA

    • Suspected pituitary disease

Treatment is individualised and monitored with regular reviews and blood tests to ensure safety and efficacy.

Benefits of treatment (when appropriate)

When properly managed can:

  • Improve mood, concentration, and sense of wellbeing

  • Increase muscle mass and bone density

  • Improve libido and erectile function

  • Improve energy levels and reduce fatigue

Risks and Monitoring

Treatment is not without risk. Ongoing monitoring is essential to minimise side effects and ensure safe use:

  • Erythrocytosis (elevated red cell count)

  • Prostate enlargement or cancer risk (monitoring PSA)

  • Sleep apnoea worsening

  • Acne, hair loss, or gynecomastia

Monitoring includes:

  • Repeat blood tests (testosterone, FBC, PSA) every 3–6 months initially, then annually

  • Periodic review of symptoms and physical health

TGA and AHPRA Compliance

At our clinic:

  • We strictly follow Therapeutic Goods Administration (TGA) guidelines for prescribing.

  • We comply with AHPRA requirements to ensure all prescribing is clinically justified and evidence-based

  • We DO NOT prescribe for lifestyle enhancement or non-medical purposes

  • We provide appropriate consent and information regarding risks, benefits, and alternatives before initiating therapy

Next Steps

If you’re concerned you may have symptoms of low testosterone:

  1. Book a consultation – We will assess your symptoms and suitability for testing

  2. Complete blood testing – We will arrange testing in line with current medical guidelines

  3. Review and planning – If medically indicated, we’ll develop a treatment plan and monitor you closely

We are committed to safe, ethical, and patient-centred hormone care.