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Pravik Solanki Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
Alfred Health, Melbourne, Victoria, Australia

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Beng Eu Prahran Market Clinic, Victoria, Australia
Department of General Practice, Melbourne Medical School, The University of Melbourne, Victoria, Australia

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Jeremy Smith Faculty of Science, University of Western Australia, Perth, Australia

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Carolyn Allan Hudson Institute of Medical Research, Melbourne, Victoria, Australia

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Kevin Lee Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia

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body fat ( 2 ). After a period of AAS abuse, cessation may result in anabolic steroid-induced hypogonadism (ASIH), a state of dysfunction that may involve a suppressed hypothalamic–pituitary–testicular (HPT) axis accompanied by physical, psychological

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Mette Bøgehave Department of Clinical Biochemistry, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Denmark

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Dorte Glintborg Department of Endocrinology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark
OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark

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Jørgen Brodersen Gram Department of Clinical Biochemistry, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Denmark

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Else-Marie Bladbjerg Department of Clinical Biochemistry, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Denmark

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Marianne Skovsager Andersen Department of Endocrinology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Johannes Jakobsen Sidelmann Department of Clinical Biochemistry, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Denmark

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Introduction Opioid medications are widely used to treat chronic non-cancer pain ( 1 ). Male hypogonadism, characterized by low concentrations of testosterone and luteinizing hormone (LH), is one of the most well-described hormonal adverse

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Nandini Shankara Narayana Andrology Department, Concord Hospital and, ANZAC Research Institute, University of Sydney, Sydney, Australia

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Lam P Ly Andrology Department, Concord Hospital and, ANZAC Research Institute, University of Sydney, Sydney, Australia

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Veena Jayadev Andrology Department, Concord Hospital and, ANZAC Research Institute, University of Sydney, Sydney, Australia

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Carolyn Fennell Andrology Department, Concord Hospital and, ANZAC Research Institute, University of Sydney, Sydney, Australia

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Sasha Savkovic Andrology Department, Concord Hospital and, ANZAC Research Institute, University of Sydney, Sydney, Australia

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Ann J Conway Andrology Department, Concord Hospital and, ANZAC Research Institute, University of Sydney, Sydney, Australia

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David J Handelsman Andrology Department, Concord Hospital and, ANZAC Research Institute, University of Sydney, Sydney, Australia

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for irreversible pathological hypogonadism needs to be life-long, the convenience of a regimen facilitates long-term compliance with therapeutic dosing. All testosterone products require individual optimizing of the patient’s regimen to ensure the best

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Rebeca Esquivel-Zuniga Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA

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Alan D Rogol Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA

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. CDGP is a diagnosis of exclusion, and alternative causes of DP should first be considered ( 5 , 6 ). These can be divided into three main categories: (1) hypergonadotropic hypogonadism, characterized by elevated levels of LH and FSH and due to gonadal

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Simon Chang Unit for Thrombosis Research, Institute of Regional Health Research, University of Southern Denmark and Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark

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Christian Fynbo Christiansen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark

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Anders Bojesen Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark

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Svend Juul Department of Public Health, Aarhus University, Aarhus C, Denmark

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Anna-Marie B Münster Unit for Thrombosis Research, Institute of Regional Health Research, University of Southern Denmark and Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark

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Claus H Gravholt Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark

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Introduction Men with 47,XXY Klinefelter syndrome (KS) commonly present hypergonadotropic hypogonadism and are commonly treated with testosterone supplementation therapy ( 1 ). However, this treatment is almost entirely based on our knowledge

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Willem de Ronde Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands

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Diederik L Smit Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands

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. However, it gives an indication that the weekly dose varies enormously between users and that the mean dose is highly supraphysiologic. For comparison, a normal substitution dose of an injectable testosterone-ester to treat male hypogonadism should not

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Giuseppe Grande Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy

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Andrea Graziani Department of Medicine, University of Padova, Padova, Italy

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Antonella Di Mambro Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy

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Riccardo Selice Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy

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Alberto Ferlin Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy
Department of Medicine, University of Padova, Padova, Italy

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prevalence of 1:600 ( 6 )–1:660 men ( 7 ), although it is often under-recognized and, due to that, it has an expected increasing prevalence ( 8 , 9 ). Moreover, KS is the most frequent cause of hypergonadotropic hypogonadism in men ( 10 ). Most KS patients

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Yijun Tang Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Yao Chen Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Jiayi Wang Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Qianwen Zhang Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Yirou Wang Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Yufei Xu Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Xin Li Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Jian Wang International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Xiumin Wang Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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in patients with suspected hypogonadotropic hypogonadism and healthy control groups (1:1 matched). Inclusion criteria were as follows: (i) aged 6–18 years old; (ii) willing to participate in this study; (iii) no difficulty in language communication

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Simon Chang Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Internal Medicine, Lillebaelt Hospital, Kolding, Denmark

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Arkadiusz J Goszczak NanoSYD, The Mads Clausen Institute, University of Southern Denmark, Sønderborg, Denmark

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Anne Skakkebæk Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark

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Jens Fedder Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark

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Anders Bojesen Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark

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M Vakur Bor Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark

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Moniek P M de Maat Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
Department of Haematology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

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Claus H Gravholt Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark

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Anna-Marie B Münster Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark

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hypergonadotropic hypogonadism is virtually omnipresent in adult men with KS ( 1 ), resulting in an unfavourable metabolic profile characterized by dyslipidaemia, hypertension and increased visceral fat mass ( 1 , 5 , 6 ). Obesity is considered a causal risk

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M Jensterle Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia

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A Podbregar University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia

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K Goricar University of Ljubljana, Faculty of Medicine, Institute of Biochemistry, Pharmacogenetics Laboratory, Ljubljana, Slovenia

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N Gregoric Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia

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A Janez Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia

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Introduction Obesity causes functional hypogonadism (FH) due to suppression of hypothalamus-pituitary-testicular (HPT) axis that is potentially reversible ( 1 ). Recent evidence suggests that weight reduction (WR) with lifestyle measures (LSMs

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