Patient case (clinical description): A 19-year-old male came to clinic with some sexual concern.  He recently engaged in a relationship and is worried about the satisfaction of his girlfriend. He has a "baby face" according to his girlfriend's statement and he is not as muscular as his classmates.  On physical examination, there is some pubic hair and poorly developed secondary sexual characteristics. He is unable to detect coffee smell during the examination, but the visual acuity is normal. Ultrasound reveals the testes volume of 1-2 ml. The hormonal evaluation showed serum testosterone level of 65 ng/dL with low levels of GnRH.

Patient's own account: I'm 19 years old guy and I just went to see a doctor at the clinic after I just got with my girlfriend. I'm kinda worried because she thinks that I have a baby face and to be honest, I'm way less muscular than my classmates. I don't have much hair down there, and yes, I don't have that macho look. The doctor made me smell some coffee and I couldn't smell anything special. I also had some eyesight checkups and the doctor told me everything was normal. I got my test results back and it says: testes volume is 1-2 ml and serum testosterone level of 65 ng/dL with low GnRH levels.

Clinical trial: Safety and Efficacy of Intranasal TBS-1 Treatment of Male Hypogonadism

Eligibility criteria:
Inclusion Criteria

          -  Male between 18 and 80 years of age

          -  Able to understand and provide signed informed consent

          -  Have 2 fasting morning (0900 h ± 30 min) serum total testosterone levels <300 ng/dL

          -  Body mass index between 18.5 kg/m2 and 35 kg/m2

          -  Hemoglobin level > or = 13.0 g/dL

          -  Screening laboratory assessments within ±15% of the normal range, with the exception
             of liver function tests (which need to be within the normal range) and HbA1c (which
             must be <7.0% [9.5 mmol/L]); lipid profile and endocrine profile assessments are also
             exempt from this range unless the assessments indicate a significant intercurrent
             illness other than testosterone deficiency

          -  Ear, nose and throat examination including nasal endoscopy without clinically
             significant abnormal findings

          -  Normal prostate for age based on digital rectal exam and a serum PSA <4.0 ng/mL.

        Exclusion Criteria

          -  Significant intercurrent disease of any type, in particular liver, kidney, heart
             disease, or psychiatric illness

          -  Hyperparathyroidism, uncontrolled diabetes mellitus, hypothyroidism, or
             hyperthyroidism (thyroid stimulating hormone should be <1.5 times the upper limit of
             normal)

          -  Hematocrit >54% at screening

          -  History of pituitary or hypothalamic tumors or history of malignancy within the past 5
             years, excluding basal cell or squamous cell carcinoma of the skin curatively treated
             by surgery

          -  History of nasal surgery, specifically turbinoplasty, septoplasty, rhinoplasty, "nose
             job," or sinus surgery

          -  History of nasal fractures within the past 6 months and/or prior nasal fractures that
             caused a severely deviated anterior nasal septum

          -  Active allergies, such as rhinitis, rhinorrhea, and nasal congestion

          -  Mucosal inflammatory disorders, specifically pemphigus or Sjogren's syndrome

          -  Sinus disease, specifically acute sinusitis, chronic sinusitis, or allergic fungal
             sinusitis

          -  History of nasal disorders (eg, polyposis, recurrent epistaxis [>1 nose bleed per
             month], abuse of nasal decongestants) or sleep apnea

          -  Use of any form of intranasal medication delivery, specifically nasal corticosteroids
             and oxymetazoline-containing nasal sprays (eg, Dristan® 12-Hour Nasal Spray)

          -  History of severe adverse drug reaction or leukopenia

          -  A known hypersensitivity to lidocaine or any materials that may be used during the
             study

          -  History of abnormal bleeding tendencies or thrombophlebitis unrelated to venipuncture
             or intravenous cannulation

          -  History of hepatitis B, a positive test for hepatitis B surface antigen, a history of
             hepatitis C, or a positive test for hepatitis C antibody

          -  Presence of human immunodeficiency virus infection or antibodies

          -  History of asthma and ongoing asthma treatment

          -  History of sleeping problems or a shift worker

          -  Smoker of >10 cigarettes (or equivalent) per day

          -  Regular consumption of more than 4 units of alcohol daily (1 unit is defined as 300 mL
             of beer, 1 glass of wine, or 1 measure of spirit) or difficulty abstaining from
             alcohol during the 48 hours prior to the 24 hour blood sampling visits

          -  History or current evidence of abuse of alcohol or any drug substance, licit or
             illicit, or positive urine drug and alcohol screen

          -  Treatment with androgen therapy within at least 2 weeks prior to baseline evaluations
             (subjects on androgen therapy will require a washout period of 4 weeks for depot
             products administered intramuscularly [eg, testosterone enanthate 200 mg/mL] and 2
             weeks for products administered orally or topically [oral, patch, gel, or buccal])

          -  Current treatment with other androgens (eg, dehydroepiandrosterone [DHEA]), anabolic
             steroids, or other sex hormones

          -  Treatment with estrogens, gonadotropin-releasing hormone (GnRH) agonists, or growth
             hormone within previous 12 months

          -  Treatment with drugs that interfere with the metabolism of testosterone, such as
             anastrozole, clomiphene, dutasteride, finasteride, flutamide, ketoconazole,
             spironolactone, or testolactone

          -  Treatment with any antihypertensive, antidepressant, tranquilizer, or histamine 2 (H2)
             receptor blocker that is not part of a stable regimen (stable dose for at least 3
             months prior to baseline);

          -  Poor compliance history or low likelihood of maintaining attendance

          -  Participation in any other research study during the conduct of this study or 30 days
             prior to the initiation of this study or blood donation at any time during this study
             and within the 12 week period prior to screening
Male
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 80 Years

Eligibility (NLI label): Entailment