Diagnosis and management of male hypogonadism in Germany

Background The extent to which male hypogonadism is diagnosed and treated remains ambiguous. This study scrutinizes the respective medical framework in Germany. Materials and methods This observational study retrospectively analyzes data from four million male state insurance clients, aged 30 to 80, from 2014 to 2021. It evaluates diagnostics related to hypogonadism prevalence, incidence, comorbidities, testosterone therapy (TTh) implementation, type 2 diabetes incidence, and work incapacity rates. Results According to the diagnoses, the prevalence of primary hypogonadism (0.62%) exceeded that of secondary (0.16%) and functional hypogonadism (0.09%), with both incidence and prevalence rising from 2015 to 2021. Common comorbidities included primary hypertension, back pain, and dyslipidemia. Within the first year post-diagnosis, TTh (via transdermal or intramuscular administration) was initiated in 35.22%, 36.60%, and 59.55% of patients with primary, secondary, and functional hypogonadism, respectively. Untreated primary hypogonadism patients had higher work incapacity rates compared to treated patients (17.1% vs. 9.71%; p < 0.001). Conversely, treated patients had a higher incidence of newly diagnosed type 2 diabetes (24.0% vs. 17.7%; p < 0.001). Conclusion Optimizing the diagnosis, treatment, and monitoring of male hypogonadism in clinical practice could enhance the quality of life for affected individuals and reduce societal costs.