When should I consider referring a patient with hypogonadism to an endocrinologist or urologist?

Consider referring a patient with hypogonadism to an endocrinologist if:

• There is a suspected diagnosis of hypogonadism confirmed by low serum testosterone levels or abnormalities in related hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), or prolactin.
• Testosterone replacement therapy is being considered, as specialist input is needed to manage and monitor treatment.

Consider referring to a urologist if:

• There is a penile structural abnormality or abnormal testicular examination.
• The patient is young or has a lifelong history of difficulty in obtaining or maintaining an erection, suggesting possible primary erectile dysfunction.
• There is a history of pelvic, perineal, or genital trauma that may require specialist urological assessment or intervention.

These referral recommendations are based on the British Society for Sexual Medicine (BSSM) guidelines and the European Association of Urology (EAU) guidelines, which emphasize specialist assessment for hormone abnormalities and structural or traumatic causes of erectile dysfunction and hypogonadism NICE CKS.