Systematic review of hormone replacement therapy in the infertile man

Peer review under responsibility of Arab Association of Urology.

Figures & data

Table 1 Symptoms, signs, and conditions indicative of testosterone deficiency.

Vasomotor and nervous symptoms:

• Hot flushes (similar to those of menopause in women)

• Episodes of sweating

• Insomnia and disturbed sleep rhythm

• Nervousness

Mood disorders and cognitive functions:

• Irritability and lethargy

• Decreased sense of well-being

• Lack of motivation

• Difficulties with short-term memory

• Depressive symptoms

Masculinity/virility:

• Decreased vigour and physical energy

• Diminished muscle mass (sarcopenia) and strength (sarcoasthenia)

• Loss of sexual body hair

• Abdominal obesity

• Gynaecomastia

Sexuality:

• Decreased interest or desire for sex

• Reduction of sexual activity

• Poor erectile function

• Limited quality of orgasm (unpleasurable orgasm)

• Weakness or reduction of ejaculation

Table 2 Factors increasing and decreasing SHBG and affecting free testosterone level.

Factors that increase SHBG	Factors that decrease SHBG
Hyperthyroidism	Hypothyroidism
Ageing males (PADAM)	Obesity
Oestrogens	Androgens
Hepatocellular dysfunction	Hyperinsulinaemia and insulin resistance
Anti-epileptic drugs	Hyperprolactinaemia
Tamoxifen	Acromegaly
	Hypercorticism

PADAM, partial androgen deficiency of the ageing male.

Fig. 1 Flowchart illustrating selection criteria.