Diagnosing andropause

Abstract

Testosterone levels’ decrease with age is now well documented. Indeed 20% of healthy men over 60 and 30–50% over 80 years of age have levels under the reference range. Low testosterone levels are not sufficient to diagnose age related male hypogonadism or “andropause”. Andropause diagnosis requires the presence of both low testosterone levels and clinical symptoms. Depending on the study, several cut-offs have been used in order to define low testosterone levels. The use of free testosterone as a more specific marker in cases where Sex Hormone Binding Globulin (SHBG) alterations are suspected has also been a matter of discussion. Several questionnaires have been elaborated in order to help andropause diagnosis, such as the St. Louis Androgen Deficiency in the Aging Male (ADAM) questionnaire and the Aging Male Symptom (AMS) rating. Although sensitivity was quite satisfying for both the ADAM and the AMS (88% and 96% respectively) specificity was low (60% and 30% respectively). Scores on both questionnaires reflected testosterone levels even less with higher age.