Male hypogonadism is a significant clinical syndrome characterized by testosterone deficiency and its accompanying signs and symptoms. Its prevalence increases with age and is closely associated with comorbidities such as obesity, type 2 diabetes, and metabolic syndrome. This condition can lead to multisystemic consequences, including sexual dysfunction, decreased muscle mass, reduced bone density, cognitive impairment, and a diminished overall quality of life. The management of this syndrome, frequently encountered in urological practice, requires not only the correction of testosterone levels but also the investigation of underlying causes, management of patient expectations, and careful evaluation of potential risks. The diagnostic process is based on the presence of specific symptoms and the confirmation of low total testosterone levels in at least two separate morning measurements. While testosterone replacement therapy (TRT) is the cornerstone of treatment, the decision to treat must be individualized based on the patient's age, comorbidities, fertility desires, and potential contraindications. The risks of TRT and alternative treatment options should be carefully considered, especially in men planning fertility or in cases of prostate and breast cancer. Effective management of male hypogonadism necessitates a multidisciplinary approach centered around the urologist, involving collaboration with endocrinology, cardiology, andrology, and primary care physicians. This chapter summarizes the current diagnostic, therapeutic, and management strategies for male hypogonadism from a urological perspective, in light of international guidelines.