Clinical Evaluation

Abstract

The evaluation of the man with suspected hypogonadism and/or infertility begins with a directed history and physical examination on specific elements that help to determine the likely onset and possible causes of the androgen deficiency or infertility. Determination of the onset and possible causes of androgen deficiency or infertility is essential for determination of a rational diagnostic evaluation. For example, in the adult man who has testes are very small (≤6 cc each) has prepubertal onset of male hypogonadism. Congenital causes of hypogonadism such as Klinefelter syndrome and Kallmann syndrome become much more likely as aetiologies whereas acquired causes such as sellar masses and metabolic disorders such as hemochromatosis more commonly present postpubertally (because they take time to progress to hypogonadism) or there are clues to the acquired causes such as major testicular or hypothalamic disease or surgery when they occur pre- or peripubertally. Finally, the history and physical examination is indispensable in determining the potential benefits and risks of therapy for man with suspected androgen deficiency or infertility. This chapter introduces the reader into the rationale approach history taking and the physical examination of the man with possible hypogonadism.