The new AACE guidelines include a detailed discussion of clinical and laboratory findings, plus a diagnosis and treatment algorithm based on testicular size, hormone levels, and semen analysis. The revision is the first since the guidelines were initially issued in 1996.

It is important to focus attention on the recognition and treatment of the disorder because many men are reluctant to discuss the symptoms of hypogonadism with their physicians. Symptoms usually include decreased libido, impotence, decreased muscle mass, fatigue, and decreased bone density.

“Many men don’t seek out medical attention for health problems in the early stage,” Dr. Petak said. “And they don’t feel comfortable talking about the major symptom, loss of libido.”

Even if patients do mention decreased sexual urge, physicians might be more likely to prescribe Viagra than to perform a full evaluation. “Lots of physicians don’t delve into the matter too deeply, either for lack of time or because of the level of discomfort,” he said. A thorough evaluation is important because hypogonadism may arise from problems with the testes, pituitary, or hypothalamus, or by a genetic disorder.

The AACE guidelines are aimed at three target populations:

Men with primary testicular failure who require hormone replacement.

Men with gonadotropin deficiency or dysfunction who may have received testosterone replacement therapy or treatment for infertility.

Aging men who could benefit from testosterone therapy.