Abstract
Introduction. Though the clinical significance of testosterone deficiency is becoming increasingly apparent, its prevalence in the general population remains unrecognised. A large web-based survey was undertaken over 3 years to study the scale of this missed diagnosis.Methods. An online questionnaire giving the symptoms characterising testosterone deficiency syndrome (Aging Male Symptoms – AMS – scale) was set up on three web sites, together with questions about possible contributory factors.Results. Of over 10,000 men, mainly from the UK and USA, who responded, 80% had moderate or severe scores likely to benefit from testosterone replacement therapy (TRT). The average age was 52, but with many in their 40s when the diagnosis of ‘late onset hypogonadism’ is not generally considered. Other possible contributory factors to the high testosterone deficiency scores reported were obesity (29%), alcohol (17.3%), testicular problems such as mumps orchitis (11.4%), prostate problems (5.6%), urinary infection (5.2%) and diabetes 5.7%.Conclusions. In this self-selected large international sample of men, there was a very high prevalence of scores which if clinically relevant would warrant a therapeutic trial of testosterone treatment. This study suggests that there are large numbers of men in the community whose testosterone deficiency is neither being diagnosed nor treated.
Highlights
Though the clinical significance of testosterone deficiency is becoming increasingly apparent, its prevalence in the general population remains unrecognised
While there may have been a few respondents in their 20s or earlier who were just experimenting with the Aging Male Symptoms (AMS) questionnaire, it is remarkable that because of spread of the normal distribution curve, 13% were below the age of 40, and another 27% in their 40s, i.e. 40% at ages when ‘Late Onset Hypogonadism’ is generally not recognised as occurring
The prevalence of related factors is described in the discussion section. This was not a random survey of the general population, but was biased towards those searching the web for an explanation of symptoms they thought might be related to testosterone deficiency
Summary
Though the clinical significance of testosterone deficiency is becoming increasingly apparent, its prevalence in the general population remains unrecognised. As well as the key symptoms of loss of energy, drive, libido and impaired erectile function, there is often depression, memory loss and increased irritability which can impair work, home and social life This has been causally linked to a wide range of medical conditions [1] including metabolic syndrome [2], diabetes [3], cardiovascular disease [4], osteoporosis [5], Alzheimer’s disease [6], depression [7], frailty [8] and even premature death [9]. Many of the conditions seen in aging populations world-wide which lead to frailty and disability can be prevented by such treatment, making it an effective form of preventive medicine In view of these benefits, it was decided to undertake a webbased survey of the prevalence of symptomatic testosterone deficiency
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