Anticipated Stigma, Illness Identity, and Quality of Life in Male Hypogonadism

Hypogonadism is a chronic endocrine condition characterized by subnormal serum testosterone levels. Unlike other chronic metabolic conditions, hypogonadism directly threatens core attributes of male gender identity, including sexual function, physical capacity, and reproductive potential. While biological manifestations and medical management are well documented, the psychosocial dimensions of hypogonadism, specifically anticipated stigma and illness identity, remain insufficiently explored in clinical research.

Anticipated stigma involves cognitive expectations of negative reactions, judgment, or discrimination from interpersonal, occupational, and healthcare environments. In conditions where illness poses a direct threat to gender role identity, anticipated stigma may be heightened compared to non-identity-threatening chronic conditions such as diabetes or hypertension. Furthermore, the degree to which an individual integrates the diagnosis into their self-concept (illness identity) may interact with anticipated stigma to exacerbate health-related quality-of-life impairments.

This study systematically evaluates anticipated stigma and illness identity in men with hypogonadism in comparison to age-matched controls with other chronic endocrine conditions treated in the same clinical setting. The primary objective is to determine whether anticipated stigma levels differ significantly between these groups and to examine the predictive capacity of anticipated stigma and illness identity on disease-specific symptom burden and quality-of-life outcomes within the hypogonadism cohort.

Inclusion criteria

Cases:

• Male, aged 18 years or older.
• Biochemically confirmed hypogonadism (total testosterone < 300 ng/dL with at least one clinical symptom).
• Regular follow-up at the endocrinology outpatient clinic.
• Fluent in reading and understanding Turkish.
• Signed informed consent.

Controls:

• Male, aged 18 years or older.
• Diagnosed with diabetes, hypertension, or hypothyroidism under regular endocrinology follow-up.
• Total testosterone ≥ 300 ng/dL.
• Age-matched to a participant in the case group (±5 years).
• Fluent in reading and understanding Turkish.
• Signed informed consent.

Exclusion criteria

• Active psychiatric diagnosis (e.g., active psychosis, bipolar disorder).
• Chronic inflammatory or rheumatological diseases affecting body composition (e.g., chronic kidney disease, IBD, rheumatoid arthritis, SLE, ankylosing spondylitis).
• Uncontrolled co-existing endocrine conditions or severe complications (e.g., HbA1c > 8.0%, diabetic neuropathy/nephropathy/retinopathy, non-euthyroid state).
• Cognitive impairment or dementia precluding questionnaire completion.
• Klinefelter syndrome.
• Literacy limitations preventing completion of self-report measures.
• Additional control exclusion: Diagnosis or clinical suspicion of hypogonadism.