Evaluation of Endocrine Disorders of the Hypothalamic-Pituitary-Gonadal (HPG) Axis

Among male adolescents, lack of spontaneous pubertal development is a common reason for presenting for endocrine evaluation. Among adult men, symptoms of androgen deficiency, sexual dysfunction and/or infertility are chief complaints that often motivate patients to seek reproductive endocrine consultation. Obtaining a comprehensive medical history, performing a clinical examination and conducting laboratory diagnostic testing are cornerstones for evaluating the hypothalamic-pituitary-gonadal (HPG) axis. Sexuality and reproduction can be sensitive topics and some patients may find it challenging to discuss such matters. Herein we present best nursing practices for history taking and review the clinical competencies for physical examination. The rationale and value of specific hormone assays and the role of stimulation testing will be reviewed in relation to clinical decision-making as well as the appropriate use of imaging studies. Male reproductive disorders may span several domains including endocrinology, andrology, urology and genetics. Thus, appropriate referrals and coordination of care are important factors for management. This chapter is a mini-review for endocrine nurses providing a synopsis of the approach to and evaluation of patients with hypogonadism, sexual dysfunction and infertility. Particular emphasis is placed on providing comprehensive coordinated care that includes patient education, anticipatory guidance and addressing patients’ psychosocial concerns.