Male hypogonadism in transition age: fertility outcomes and practical management

Background: The transition from childhood to adulthood represents a critical period for the onset and management of male hypogonadism. During this phase, both hypogonadotropic and hypergonadotropic forms may emerge, often presenting as delayed puberty. Early diagnosis is essential for appropriate management and fertility preservation. This review aims to provide a comprehensive overview of male hypogonadism during the transition age, focusing on its classification, clinical implications, fertility outcomes, and preservation strategies. Aims: This review aims to synthesize current evidence on the diagnosis, clinical presentation, and management of male hypogonadism during the transition age, with a specific focus on fertility outcomes and preservation strategies across different etiologies, including both congenital and acquired forms. Conclusions: The management of male hypogonadism during the transition age should be approached on an individual basis, with consideration given to the underlying etiology, the age of the patient, and the possibilities for fertility preservation. Fertility preservation may involve hormonal therapies or surgical techniques, such as TESE or microTESE. The choice of technique should be guided by a multidisciplinary team. It is imperative that decisions are tailored on a case-by-case basis, with due consideration given to clinical presentation and surgical expertise, in order to optimise long-term reproductive outcomes.