Care of Patients with Male Hypogonadism: A Joint Position Statement from the Brazilian Society of Endocrinology and Metabolism (SBEM), the Brazilian Society of Urology (SBU), and the Brazilian Association for Sexual Medicine and Health (ABEMSS)

Abstract

Male hypogonadism is a prevalent and clinically relevant condition with substantial effects on reproductive, metabolic, skeletal, and psychosocial health. Rising obesity rates, metabolic syndrome, and anabolic-androgenic steroid use have increased the frequency of functional hypogonadism in Brazil. Despite advances in diagnosis and treatment, clinical practice remains heterogeneous and access to standardized recommendations is limited. This joint position statement from the Department of Female Endocrinology, Andrology and Transgenderism (DEFAT) of the Brazilian Society of Endocrinology and Metabolism (SBEM), the Brazilian Society of Urology (SBU), and the Brazilian Association for Sexual Medicine and Health (ABEMSS) provides practical, evidence-based guidance for the evaluation and management of male hypogonadism in Brazil. The document outlines diagnostic criteria, including morning total testosterone confirmation and assessment of gonadotropins, and emphasizes recognition of functional etiologies such as obesity-related hypogonadism. Therapeutic recommendations include testosterone replacement therapy for confirmed organic hypogonadism, preferential use of long-acting intramuscular or transdermal formulations, and fertility-preserving strategies (SERMs, hCG, aromatase inhibitors) when indicated. The statement also addresses monitoring protocols, safety considerations, and the management of adverse effects. This is the first multidisciplinary Brazilian guideline harmonizing endocrine, urological, and sexual medicine perspectives to support national clinical practice. This consensus aims to promote consistent clinical decision-making, reduce underdiagnosis and overtreatment, and ensure safe, individualized care aligned with international principles and adapted to the national context.