Hypogonadism — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 73 of 2021

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting hypogonadism or death from hypogonadism with the circumstances of a person's relevant service:

1. (1)
   having hypopituitarism involving deficiency of follicle stimulating hormone or luteinising hormone at the time of the clinical onset of hypogonadism;
2. (2)
   having hyperprolactinaemia at the time of the clinical onset of hypogonadism;
3. (3)
   for males only, having a spinal cord injury resulting in paraplegia or tetraplegia before the clinical onset of hypogonadism;
4. (4)
   having blunt or penetrating trauma to: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; sufficient to cause gonadal atrophy before the clinical onset of hypogonadism;
5. (5)
   having surgical excision of: (a) both ovaries or testes; or Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022 (b) a single functional ovary or testis, where there is only one functional ovary or testis; before the clinical onset of hypogonadism;
6. (6)
   undergoing a course of therapeutic radiation for cancer, where: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; were in the field of radiation before the clinical onset of hypogonadism;
7. (7)
   having infection with human immunodeficiency virus before the clinical onset of hypogonadism;
8. (8)
   having infection with Mycobacterium leprae before the clinical onset of hypogonadism;

   Note: Mycobacterium leprae is the organism that causes leprosy.

9. (9)
   having infection with Trypanosoma brucei before the clinical onset of hypogonadism;

   Note: Trypanosoma brucei is the organism that causes African sleeping sickness (trypanosomiasis).

10. (10)
    having mumps orchitis as an adult affecting: (a) both testes; or (b) a single functional testis, where there is only one functional testis; before the clinical onset of hypogonadism;
11. (11)
    for males only, having rheumatoid arthritis or granulomatosis with polyangiitis before the clinical onset of hypogonadism;
12. (12)
    having Addison disease before the clinical onset of hypogonadism;
13. (13)
    having an infiltrative disease from the specified list of infiltrative diseases of: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; before the clinical onset of hypogonadism; Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022;

    Note: specified list of infiltrative diseases is defined in the Schedule 1 - Dictionary.

14. (14)
    for males only, having a testicular varicocoele before the clinical onset of hypogonadism;
15. (15)
    having infarction of: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; within the 1 year before the clinical onset of hypogonadism;
16. (16)
    having sickle-cell disorder before the clinical onset of hypogonadism;
17. (17)
    having a bone marrow or stem cell transplant before the clinical onset of hypogonadism;
18. (18)
    having cirrhosis of the liver at time of the clinical onset of hypogonadism;
19. (19)
    having chronic kidney disease at time of the clinical onset of hypogonadism;

    Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

20. (20)
    having anorexia nervosa at the time of the clinical onset of hypogonadism;
21. (21)
    taking a course of systemic cytotoxic drugs for treatment of a malignant neoplasm before the clinical onset of hypogonadism;
22. (22)
    taking gonadotrophin releasing hormone agonists or antagonists as androgen or estrogen deprivation therapy for at least 1 year within the 2 years before the clinical onset of hypogonadism;
23. (23)
    having active epilepsy before the clinical onset of hypogonadism;

    Note: active epilepsy is defined in the Schedule 1 - Dictionary.

24. (24)
    taking a drug from the Specified List 1 of drugs before the clinical onset of hypogonadism;

    Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

25. (25)
    taking an immune checkpoint inhibitor within the 1 year before the clinical onset of hypogonadism;

    Note: immune checkpoint inhibitor is defined in the Schedule 1 - Dictionary.

26. (26)
    taking a drug from the Specified List 2 of drugs, which cannot be ceased or substituted, at the time of the clinical onset of hypogonadism; Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022;

    Note: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.

27. (27)
    taking a drug which cannot be ceased or substituted and which is associated in the individual with the clinical onset of hypogonadism during drug therapy and either: (a) the improvement of hypogonadism within 2 months of discontinuing or tapering drug therapy; or (b) the redevelopment of hypogonadism on rechallenge with the same drug; and where taking the drug continued for at least the 30 days before the clinical onset of hypogonadism;
28. (28)
    inhaling fumes from a metal from the specified list of metals or a compound containing a metal from the specified list of metals: (a) for a cumulative period of at least 2,000 hours before the clinical onset of hypogonadism; and (b) if that exposure has ceased before the clinical onset of hypogonadism, then that onset occurred within 2 years of cessation;

    Note: fumes and specified list of metals are defined in the Schedule 1 - Dictionary.

29. (29)
    inhaling, ingesting or having cutaneous contact with a chemical agent from the specified list of chemical agents: (a) for a cumulative period of at least 2,000 hours before the clinical onset of hypogonadism; and (b) if that exposure has ceased before the clinical onset of hypogonadism, then that onset occurred within 2 years of cessation;

    Note: specified list of chemical agents is defined in the Schedule 1 - Dictionary.

30. (30)
    for females only, inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para- dioxin (TCDD): (a) for a cumulative period of at least 1,000 hours, within a consecutive period of 10 years before the clinical onset of hypogonadism; and (b) if that exposure has ceased before the clinical onset of hypogonadism, then that onset occurred within 25 years of cessation; Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022;

    Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

31. (31)
    for females only, having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical onset of hypogonadism; and (b) if smoking has ceased before the clinical onset of hypogonadism, then that onset occurred within 10 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

32. (32)
    having alcohol use disorder before the clinical onset of hypogonadism;
33. (33)
    being obese for at least the 5 years before the clinical onset of hypogonadism;

    Note: being obese is defined in the Schedule 1 - Dictionary.

34. (34)
    for females only, being underweight for at least the 5 years before the clinical onset of hypogonadism;

    Note: being underweight is defined in the Schedule 1 - Dictionary.

35. (35)
    for females only, being nulliparous at the time of the clinical onset of hypogonadism;

    Note: being nulliparous is defined in the Schedule 1 - Dictionary.

36. (36)
    for parous women only, an inability to breast feed for a cumulative period of at least 6 months before the clinical onset of hypogonadism;

    Note: The period of breastfeeding could be cumulative over a number of pregnancies.

37. (37)
    having diabetes mellitus before the clinical onset of hypogonadism;
38. (38)
    for males only, having obstructive sleep apnoea at the time of the clinical onset of hypogonadism;
39. (39)
    having hypopituitarism involving deficiency of follicle stimulating hormone or luteinising hormone at the time of the clinical worsening of hypogonadism;
40. (40)
    having hyperprolactinaemia at the time of the clinical worsening of hypogonadism;
41. (41)
    for males only, having a spinal cord injury resulting in paraplegia or tetraplegia before the clinical worsening of hypogonadism;
42. (42)
    having blunt or penetrating trauma to: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022 sufficient to cause gonadal atrophy before the clinical worsening of hypogonadism;
43. (43)
    having surgical excision of: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; before the clinical worsening of hypogonadism;
44. (44)
    undergoing a course of therapeutic radiation for cancer, where: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; were in the field of radiation before the clinical worsening of hypogonadism;
45. (45)
    having infection with human immunodeficiency virus before the clinical worsening of hypogonadism;
46. (46)
    having infection with Mycobacterium leprae before the clinical worsening of hypogonadism;

    Note: Mycobacterium leprae is the organism that causes leprosy.

47. (47)
    having infection with Trypanosoma brucei before the clinical worsening of hypogonadism;

    Note: Trypanosoma brucei is the organism that causes African sleeping sickness (trypanosomiasis).

48. (48)
    having mumps orchitis as an adult affecting: (a) both testes; or (b) a single functional testis, where there is only one functional testis; before the clinical worsening of hypogonadism;
49. (49)
    for males only, having rheumatoid arthritis or granulomatosis with polyangiitis before the clinical worsening of hypogonadism;
50. (50)
    having Addison disease before the clinical worsening of hypogonadism;
51. (51)
    having an infiltrative disease from the specified list of infiltrative diseases of: Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022 (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; before the clinical worsening of hypogonadism;

    Note: specified list of infiltrative diseases is defined in the Schedule 1 - Dictionary.

52. (52)
    for males only, having a testicular varicocoele before the clinical worsening of hypogonadism;
53. (53)
    having infarction of: (a) both ovaries or testes; or (b) a single functional ovary or testis, where there is only one functional ovary or testis; within the 1 year before the clinical worsening of hypogonadism;
54. (54)
    having sickle-cell disorder before the clinical worsening of hypogonadism;
55. (55)
    having a bone marrow or stem cell transplant before the clinical worsening of hypogonadism;
56. (56)
    having cirrhosis of the liver at time of the clinical worsening of hypogonadism;
57. (57)
    having chronic kidney disease at time of the clinical worsening of hypogonadism;

    Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

58. (58)
    having anorexia nervosa at the time of the clinical worsening of hypogonadism;
59. (59)
    taking a course of systemic cytotoxic drugs for treatment of a malignant neoplasm before the clinical worsening of hypogonadism;
60. (60)
    taking gonadotrophin releasing hormone agonists or antagonists as androgen or estrogen deprivation therapy for at least 1 year within the 2 years before the clinical worsening of hypogonadism;
61. (61)
    having active epilepsy before the clinical worsening of hypogonadism;

    Note: active epilepsy is defined in the Schedule 1 - Dictionary.

62. (62)
    taking a drug from the Specified List 1 of drugs before the clinical worsening of hypogonadism; Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022;

    Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

63. (63)
    taking an immune checkpoint inhibitor within the 1 year before the clinical worsening of hypogonadism;

    Note: immune checkpoint inhibitor is defined in the Schedule 1 - Dictionary.

64. (64)
    taking a drug from the Specified List 2 of drugs, which cannot be ceased or substituted, at the time of the clinical worsening of hypogonadism;

    Note: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.

65. (65)
    taking a drug which cannot be ceased or substituted and which is associated in the individual with the clinical worsening of hypogonadism during drug therapy and either: (a) the improvement of hypogonadism within 2 months of discontinuing or tapering drug therapy; or (b) the clinical worsening of hypogonadism on rechallenge with the same drug; and where taking the drug continued for at least the 30 days before the clinical worsening of hypogonadism;
66. (66)
    inhaling fumes from a metal from the specified list of metals or a compound containing a metal from the specified list of metals: (a) for a cumulative period of at least 2,000 hours before the clinical worsening of hypogonadism; and (b) if that exposure has ceased before the clinical worsening of hypogonadism, then that worsening occurred within 2 years of cessation;

    Note: fumes and specified list of metals are defined in the Schedule 1 - Dictionary.

67. (67)
    inhaling, ingesting or having cutaneous contact with a chemical agent from the specified list of chemical agents: (a) for a cumulative period of at least 2,000 hours before the clinical worsening of hypogonadism; and (b) if that exposure has ceased before the clinical worsening of hypogonadism, then that worsening occurred within 2 years of cessation;

    Note: specified list of chemical agents is defined in the Schedule 1 - Dictionary.

68. (68)
    for females only, inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para- dioxin (TCDD): Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022 (a) for a cumulative period of at least 1,000 hours, within a consecutive period of 10 years before the clinical worsening of hypogonadism; and (b) if that exposure has ceased before the clinical worsening of hypogonadism, then that worsening occurred within 25 years of cessation;

    Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

69. (69)
    for females only, having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical worsening of hypogonadism; and (b) if smoking has ceased before the clinical worsening of hypogonadism, then that worsening occurred within 10 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

70. (70)
    having alcohol use disorder before the clinical worsening of hypogonadism;
71. (71)
    being obese for at least the 5 years before the clinical worsening of hypogonadism;

    Note: being obese is defined in the Schedule 1 - Dictionary.

72. (72)
    for females only, being underweight for at least the 5 years before the clinical worsening of hypogonadism;

    Note: being underweight is defined in the Schedule 1 - Dictionary.

73. (73)
    for females only, being nulliparous at the time of the clinical worsening of hypogonadism;

    Note: being nulliparous is defined in the Schedule 1 - Dictionary.

74. (74)
    for parous women only, an inability to breast feed for a cumulative period of at least 6 months before the clinical worsening of hypogonadism;

    Note: The period of breastfeeding could be cumulative over a number of pregnancies.

75. (75)
    having diabetes mellitus before the clinical worsening of hypogonadism;
76. (76)
    for males only, having obstructive sleep apnoea at the time of the clinical worsening of hypogonadism;
77. (77)
    inability to obtain appropriate clinical management for hypogonadism. Compilation No. 1 Compilation date: 30/05/2022 Authorised Version F2022C00577 registered 31/05/2022;

Aggravation-only factors: the factors in subsections 8(39) to 8(77) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.