Hypogonadism Diagnosis Criteria

[ASaxon]

I know this is basic stuff but out of all the material I’ve read the criteria for clinically diagnosing hypogonadism doesn’t seem clear to me. I’ve seen a lot on this, and other, boards about HRT and treating Hypogonadism but not on what a definitive criteria for its diagnosis.

From what I’ve read the following seems like good criteria for diagnosing basic hypogonadism.

1. At least two separate confirmatory tests with Free Testosterone being BELOW normal
or Free Testosterone being borderline with at least one of the symptoms listed in 2 below.
(Note: Total Testosterone seems to be used mainly as a entry level test for hypogonadism
but not a definitive test for a diagnosis. Am I wrong about this?)

2. At least one related symptom commonly related to Hypogonadism:
a. Mental Fog and/or Difficulty Concentrating
b. Anxiety and/or Panic Attacks
c. Depression and/or Irritability (Mood Swings)
d. Marked reduction in libido and/or Erectile Dysfunction (something that Viagra can’t fix!)
e. Signs of an osteoporosis process.
(I’ve also seen a lot of other symptoms form rapid weight loss to low lipid levels but I’m not sure
those would fit into a criteria for diagnosis.)

(Did I miss anything?)

Once basic hypogonadism is diagnosed then what is the criteria for classifying it as Primary or Secondary?

From what I read Primary has the following characteristics (Hypergonadotropic Hypogonadism):
1. Low Testosterone.
2. High LH and/or FSH

While Secondary has the following characteristics (Hypogonadotropic Hypogonadism):
1. Low Testosterone
2. Low LH and/or FSH.
(I’ve also seen “Low or inappropriately normal LH and/or FSH" used but I can’t figure out
if “inappropriately normal” means low normal, mid normal, high normal? Or if it’s
normal in the face of what specific levels of Testosterone? Anyone have any ideas?)
3. Tested and detected dysfunction in the Hypothalamus-Pituitary system
(e.g., Tumor, low GnRH production, GnRH desensitization, LH/FSH production dysfunction)

Other than the well defined genetic causes (which I’m skipping) is there anything I’m missing here?

[mranak]

To be sure, a diagnosis of hypogonadism isn't like a DSV IV diagnosis with an explicit set of rules. But we can try to define such rules anyway. Your criteria is pretty good, but would like to add that the free (or bioavailable) testosterone doesn't even have to be borderline. If, for example, the patients free testosterone is in the lower 1/2 of the range, but the patient displays all of the symptoms of hypogondism, and the symptoms disappear upon treatment, then I think it is fair to diagnose the patient with, for lack of a better term, clinical hypogonadism. Although I'm not sure about the prefix clinical, as adding this prefix is just something that I've picked up and maybe I don't properly understand its meaning.