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Hypogonadism C036

Last amended 
17 May 2022
Current RMA Instruments
Reasonable Hypothesis
73 of 2021 as amended
Balance of Probabilities
74 of 2021 as amended
SOP bulletin for new Instruments

SOP Bulletin 222

SOP Bulletin 230

ICD Coding
  • ICD-10-AM Codes:  E28.3 and E29.1.
Brief description

Hypogonadism is low/below normal function of the gonads (ovaries and testes).  In practice this means a deficiency in oestrogen or egg (ova) production in females and a deficiency in testosterone or sperm production in males. This can be from a problem with the gonads directly or it can be secondary to a disease of the pituitary or hypothalamus.

Confirming the diagnosis

In males the diagnosis is based on the clinical presentation, low serum total testosterone levels (measured on at least two occasions) and semen analysis if infertility is being evaluated.  Further testing for leutenising hormone (LH) and follicle-stimulating hormone (FSH) levels will likely be undertaken to distinguish primary from secondary hypogonadism.  Additional testing to look for causes of the condition may also be performed (e.g. MRI of pituitary gland).

In females the diagnosis is based on the clinical presentation and laboratory testing, typically including measurement of follicle-stimulating hormone (FSH) and oestradiol levels.

The relevant medical specialists are an endocrinologist, a urologist in males, and a gynaecologist in females.

Additional diagnoses covered by SOP
  • Central hypogonadism
  • Hypogonadotropic hypogonadism
  • Premature ovarian failure 
  • Primary hypogonadism
  • Primary ovarian insufficiency
  • Secondary hypogonadism
Conditions excluded from SOP
  • Abnormal semen anlysis (without low testosterone)#
  • Compensated male hypogonadism (without low testosterone)#
  • Congenital and hereditable forms of hypogonadism#
  • Diminished ovarian reserve#
  • Hypopituitarism* (may be an additional diagnosis to (secondary) hypogonadism)

* another SOP applies

# non-SOP condition

Clinical onset

Clinical onset will be based on the timing of onset of relevant symptoms, such as new menstrual irregularities (oligomenorrhea or amenorrhea) and hot flashes in females.  In adult males early symptoms tend to include decreased vigor and libido and depressed mood. Decreased muscle mass and body hair, and gynaecomastia (the presence of glandular breast tissue in a male) develop later in the course of the condition.

Clinical worsening

The course of the condition depends on the underlying cause, if one is present, and whether it is amenable to treatment.  Medical therapy is available, particularly in the form of hormone replacement.  This can alleviate symptoms but will generally not restore fertility.