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Primary Hypogonadism — RACP Adult Medicine MCQ

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EasyEndocrinology & DiabetesPrimary HypogonadismRACP Adult Medicine

A 65-year-old man presents with gynaecomastia, decreased libido, and fatigue. Morning testosterone is 5.5 nmol/L (low) on two occasions. LH and FSH are both elevated. Prolactin is normal. What is the diagnosis?

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Correct answer: A — Primary hypogonadism

Low testosterone with elevated gonadotrophins (LH, FSH) confirms primary hypogonadism (testicular failure). Causes include Klinefelter syndrome (47,XXY – most common genetic cause), prior orchitis, testicular trauma/torsion, chemotherapy, and radiation. Karyotype should be checked if no clear acquired cause. Secondary hypogonadism would show low/normal LH/FSH. Testosterone replacement is indicated if symptomatic.

Reference: eTG – 2025 – Endocrinology; Endocrine Society – 2018 – Male Hypogonadism Guidelines