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Functional male hypogonadism — SCE Endocrinology MCQ

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HardReproductive EndocrinologyFunctional male hypogonadismSCE Endocrinology

A 32-year-old man requests testosterone for low energy. He has two early-morning testosterone results just below the reference range, BMI 39 kg/m², untreated obstructive sleep apnoea and haematocrit 0.53. LH and FSH are low-normal. What is the most appropriate management?

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Correct answer: C — Treat reversible causes and avoid testosterone until safety issues are addressed

Obesity and untreated sleep apnoea can lower testosterone functionally, and raised haematocrit increases testosterone-treatment risk. Immediate replacement without addressing reversible causes is unsafe. The pearl is that biochemical hypogonadism must be interpreted with symptoms, repeat morning testing and contraindications.

Reference: Endocrine Society testosterone therapy guideline, BNF