Diagnosis Of Late-onset Hypogonadism Research Articles

A Case of late-onset hypogonadism syndrome with rapidly elevated prostate specific antigen

ABSTRACT Introduction Cases of developing prostate cancer during hormone therapy for late-onset hypogonadism syndrome are rare. Objective We report a case of prostate cancer that developed and died during hormone therapy for late-onset hypogonadism syndrome. Case A 63-year-old man was diagnosed with depression around 2010. In 2011, he visited a private urologic clinic with complaints of depression and decreased libido, and was started on androgen replacement therapy (ART) with a diagnosis of late-onset hypogonadism (LOH) syndrome. His PSA was 0.87 ng/mL in 2012, but was 3.335 ng/mL at the time of his 2017 municipal checkup. He continued to receive hormone injections every 1-2 months, but his PSA was not retested. In August 2018, he had difficulty in urination and visited his local physician, who referred him to our hospital because of a markedly elevated PSA of 213.3 ng/mL. Prostate biopsy showed adenocarcinoma, Gleason score 5+4, and CT scan showed supraclavicular, mediastinal, and retroperitoneal lymph node metastases. He underwent maximal androgen blockade therapy with castration and bicalutamide. He died after PSA failure despite chemotherapy and other treatments. Conclusions There is no evidence that ART, which is the main treatment for LOH syndrome, directly causes prostate cancer. In this case, a rapid increase in PSA was observed during ART treatment, which may indicate that the treatment caused latent prostate cancer to become apparent, resulting in a rapid increase in PSA. However, in this case, the detection of prostate cancer might have been delayed because PSA levels, which were required during ART treatment, were not measured regularly. In addition, the psychiatric symptoms of LOH syndrome are similar to those of depression, and it is difficult to differentiate them. When there is a history of depression, as in this case, a more careful diagnosis and treatment strategy are required. Disclosure Work supported by industry: no.

What is a predictive factor of the efficacy of testosterone replacement for late-onset hypogonadism?

ABSTRACT Introduction Testosterone replacement therapy (TRT) is a worldwide first-choice method of treatment for late-onset hypogonadism (LOH). In the diagnosis of LOH in Japan, we use 8.5 pg/mL of serum free-testosterone (FT) level measured by RIA as a lower limit. Objective The objective of this study is to determine the predictors of the TRT efficacy for LOH. Methods A total of 56 patients who attended our men's health clinic between August 2002 and June 2021 with the data available before and after TRT were enrolled into this study. These patients were divided into responders to TRT (Group 1, n=45, 80%) and non-responders to TRT (Group 2, n=11, 20%) according to clinical response including patient's satisfaction. Evaluated parameters obtained before TRT were following: age, BMI, aging males symptoms scale (AMS), sexual health inventory for men (SHIM), serum luteinizing hormone (LH), follicular stimulating hormone (FSH), testosterone (T), FT, prolactin (PRL), estradiol (E2) and T/E ratio. For statistical analysis, we used a multivariable logistic regression model. Results Univariate analysis revealed PRL (OR 0.96; 95% CI 0.93-0.99, P<0.03), E2 (OR 0.87; 95% CI 0.77-0.98, P<0.02), T/E (OR 1.13; 95% CI 1.01-1.27, P<0.04) as predictive factors. Then we carried out multivariate analyses of these factors and determined T/E ratio as an independent predictive factor (OR 1.16; 95% CI 1.04-1.29, P<0.01). Conclusion This study suggested that low value of T/E ratio might predict the low response to TRT. Although further study with a larger number of patients is necessary, we propose the measurement of serum E2 level as well as testosterone level before TRT. Disclosure Work supported by industry: no.

Late-onset Hypogonadism: Bone health.

Bone health is underdiagnosed and undermanaged in men. Bone loss occurs in men with hypogonadism and in aging men. Thus, patients with a diagnosis of late-onset hypogonadism (LOH) are at risk of osteoporosis and osteoporotic fractures. To provide an update on research data and clinical implications regarding bone health in men with LOH by reviewing literature articles on this issue. A thorough search of listed publications in PubMed on bone health in older men with hypogonadism was performed, and other articles derived from these publications were further identified. Late-onset Hypogonadism may be associated with reduced bone mineral density (BMD). In a pathophysiological perspective, the detrimental effects of testosterone (T) deficiency on BMD are partly ascribed to relative estrogen deficiency and both serum T and serum estradiol (E2) need to be above 200ng/dL and 20pg/mL to prevent bone loss. The effects of exogenous T on BMD are controversial, but most of the studies confirm that testosterone replacement therapy (TRT) increases BMD and prevents further bone loss in men with hypogonadism. No data are available on TRT and the prevention of fractures. In men with documented LOH, a specific clinical workup should be addressed to the diagnosis of osteoporosis in order to program subsequent follow-up and consider specific bone active therapy. TRT should be started according to guidelines of male hypogonadism while keeping in mind that it may also have positive effects also on bone health in men with LOH.

247 Correlation between testosterone to estradiol ratio and score on the aging males’ symptom scale in late-onset hypogonadism

In the diagnosis of late-onset hypogonadism (LOH) syndrome, total testosterone (T) levels and symptom scores such as those of the Aging Males’ Symptom Scale (AMS) are considered essential. However, T levels are not generally correlated with symptom scores, making diagnosis difficult. Objective parameters correlated with subjective symptoms would be useful for more accurate diagnosis. The major source of estradiol (E2) in men is conversion from T via aromatase enzyme, and the ratio of T to E2 (T/E ratio) is thought to reflect aromatase activity. Although the T/E ratio has been investigated well in the field of male infertility, there have been few reports of its use in LOH syndrome. We investigated whether there was a correlation between the T/E ratio and the AMS. A consecutive series of 155 patients attending our unit for LOH syndrome (LOH group) and 158 patients with urological problems unrelated to LOH or sexuality (control group) was studied. The relationship between T/E ratio and AMS (both total score and each subscale score) was examined in both groups.

The CATCH checklist to investigate adult-onset hypogonadism.

Adult-onset hypogonadism is a syndrome often underdiagnosed, undertreated, or incompletely explored. There are various reasons for this: firstly, undefined age range of men in whom testosterone levels should be investigated and then no definitive serum cutoff point for the diagnosis of hypogonadism; and finally, variable and non-specific signs and symptoms; men and physicians do not pay adequate attention to sexual health. All these factors make the diagnostic criteria for hypogonadism controversial. The evaluation of the clinical features and causes of this syndrome, its link with age, the role of testosterone and other hormone levels, and the presence of any comorbidities are all useful factors in the investigation of this population. The purpose of this manuscript, after an accurate analysis of current literature, is to facilitate the diagnosis of hypogonadism in men through the use of the CATCH acronym and a checklist to offer a practical diagnostic tool for daily clinical practice. A narrative review of the relevant literature regarding the diagnosis of late-onset hypogonadism or adult-onset hypogonadism was performed. PubMed database was used to retrieve articles published on this topic. A useful new acronym CATCH (Clinical features [symptoms] and Causes, Age, Testosterone level, Comorbidities, and Hormones) and a practical checklist to facilitate the evaluation of hypogonadism in aging men were used. The evaluation of the clinical features and causes of hypogonadism, the link with age, the role of Testosterone and other hormones, and the evaluation of comorbidities are important in investigating adult-onset hypogonadism. The CATCH checklist could be helpful for clinicians for an early diagnosis of both hypogonadism and associated comorbidities. We suggest the use of this acronym to advocate the investigation of declining testosterone in aging men.

Androgen Receptor CAG Repeat Length as a Risk Factor of Late-Onset Hypogonadism in a Korean Male Population.

BackgroundTestosterone action is mediated through the androgen receptor (AR), whose sensitivity is influenced by the AR CAG repeat polymorphism. However, the relation between late-onset hypogonadism (LOH) and AR CAG repeat length is unclear and studies of Asian populations are limited.AimTo investigate the relation between AR CAG repeat length and LOH in Korean men.Methods263 Korean men (mean age = 63.43 ± 10.9 years) were enrolled from 2014 to 2015. LOH diagnosis was based on a serum testosterone level lower than 3.5 ng/mL and positive androgen deficiency according to the Aging Males’ Symptom Scale (AMS). Total testosterone levels and answers to the LOH-related questionnaire were analyzed.OutcomesThe relation between AR CAG repeat length and LOH was determined.ResultsMean CAG repeat length was 22.1 ± 4.6 and mean serum testosterone levels were 2.6 ± 0.7 and 6.0 ± 2.0 ng/mL in men with and without LOH, respectively. Men with LOH showed significantly longer AR CAG repeat lengths than men without LOH (26.1 vs 21.6, P < .001). Longer CAG repeat lengths were correlated with higher AMS total scores (r = 0.454, P = .001) and AMS psychotic, somatic, and sexual sub-scores (r = 0.276, 0.246, and 0.571, P = .006, .007, .001, respectively) and significantly lower 5-item International Index of Erectile Function scores (r = −0.261, P = .001). Multivariate analysis showed that patient age and CAG repeat length were independently associated with LOH (odds ratio = 1.05 and 1.29, P = .041 and <.001, respectively).Clinical ImplicationsA longer CAG repeat length is associated with LOH symptoms and LOH.Strengths and LimitationsAssociations between CAG repeats and LOH were verified in Korean patients. Moreover, a longer CAG repeat length was shown to be an independent risk factor for LOH. Limitations included the small number of LOH patients studied and that other sex hormone-associated factors were not measured.ConclusionsAR CAG repeat length was associated with LOH prevalence and clinical symptoms in this Korean male population. Thus, it is important to measure CAG repeat length for patients with LOH symptoms with normal testosterone levels.Kim JW, Bae YD, Ahn ST, et al. Androgen Receptor CAG Repeat Length as a Risk Factor of Late-Onset Hypogonadism in a Korean Male Population. Sex Med 2018;6:203–209.

Serum testosterone levels in male hypogonadism: Why and when to check-A review.

SummaryAimAlthough “late onset hypogonadism”, a condition that includes low testosterone and symptoms, is common in men over the age of 40 years, diagnosis is not clear cut amongst non‐specialists. It is the aim of this review to provide an up to date picture of how this state should be diagnosed and managed.MethodsWe aim to describe how primary and secondary hypogonadism should be excluded before the diagnosis of late onset hypogonadism is reached. As laboratory testosterone measurements are essential the current pitfalls such as inappropriate sample collection and the use of population derived reference ranges are expanded. We review current evidence to determine associations between late onset hypogonadism and morbidity/mortality and benefits following testosterone replacement therapy.ResultsA review of the current evidence shows that late onset hypogonadism is associated with a worse metabolic state and increased mortality. Longitudinal studies have suggested that significant reductions in both symptoms and mortality are seen, especially in patients with type 2 diabetes.DiscussionThis review highlights the importance of diagnosing late onset hypogonadism due to its association with morbidity/mortality and benefits following testosterone replacement. Thus, after making recommendations to ensure correct diagnosis we speculate whether the time has come to move away from population derived testosterone levels towards evidence based action limits.

Applying machine learning techniques to the identification of late-onset hypogonadism in elderly men.

In the diagnosis of late-onset hypogonadism (LOH), the Androgen Deficiency in the Aging Male (ADAM) questionnaire or Aging Males’ Symptoms (AMS) scale can be used to assess related symptoms. Subsequently, blood tests are used to measure serum testosterone levels. However, results obtained using ADAM and AMS have revealed no significant correlations between ADAM and AMS scores and LOH, and the rate of misclassification is high. Recently, many studies have reported significant associations between clinical conditions such as the metabolic syndrome, obesity, lower urinary tract symptoms, and LOH. In this study, we sampled 772 clinical cases of men who completed both a health checkup and two questionnaires (ADAM and AMS). The data were obtained from the largest medical center in Taiwan. Two well-known classification techniques, the decision tree (DT) and logistic regression, were used to construct LOH prediction models on the basis of the aforementioned features. The results indicate that although the sensitivity of ADAM is the highest (0.878), it has the lowest specificity (0.099), which implies that ADAM overestimates LOH occurrence. In addition, DT combined with the AdaBoost technique (AdaBoost DT) has the second highest sensitivity (0.861) and specificity (0.842), resulting in having the best accuracy (0.851) among all classifiers. AdaBoost DT can provide robust predictions that will aid clinical decisions and can help medical staff in accurately assessing the possibilities of LOH occurrence.

Age-Related Testosterone Decline: Whom Do We Treat and Why?

Late-onset hypogonadism (LOH) is characterized by hypogonadal symptoms, together with low serum testosterone values, in men of advancing age. For a variety of reasons, LOH has become popular in both the lay press and the scientific community. While the overall prevalence of LOH is relatively low, the potential sequelae of untreated LOH can be considerable for affected men. The diagnosis of LOH can be challenging, as symptoms are generally nonspecific and overlap with a variety of medical and psychological problems. Testosterone therapy (TTh) for affected men has become increasingly controversial after several recent observational studies observed an increased cardiovascular risk associated with TTh. However, prior studies have observed little or no cardiovascular risk associated with TTh, and recent studies also support a low cardiovascular risk in men on TTh. In this review, we discuss the LOH patient and controversy surrounding this condition and outline potential risks and benefits of treatment.

MP76-11 EFFECTS OF 8-YEAR TREATMENT OF LONG-ACTING TESTOSTERONE UNDECANOATE ON METABOLIC PARAMETER, URINARY SYMPTOMS, BONE MINERAL DENSITY AND SEXUAL FUNCTION IN MEN WITH LATE ONSET HYPOGONADISM

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2016MP76-11 EFFECTS OF 8-YEAR TREATMENT OF LONG-ACTING TESTOSTERONE UNDECANOATE ON METABOLIC PARAMETER, URINARY SYMPTOMS, BONE MINERAL DENSITY AND SEXUAL FUNCTION IN MEN WITH LATE ONSET HYPOGONADISM Sompol Permpongkosol, Kalayanee Khupulsup, Supatra Leelaphiwat, Sarawan Pavavattananusorn, and Tanoon Pettong Sompol PermpongkosolSompol Permpongkosol More articles by this author , Kalayanee KhupulsupKalayanee Khupulsup More articles by this author , Supatra LeelaphiwatSupatra Leelaphiwat More articles by this author , Sarawan PavavattananusornSarawan Pavavattananusorn More articles by this author , and Tanoon PettongTanoon Pettong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1862AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The long term effects of long acting testosterone undecanoate (TU) and the CAG repeats Length in a large number of Thai late onset hypogonadism (LOH) men has not yet been reported. This study analyzed the 8-year follow-up effects of intramuscular TU therapy on metabolic parameter, urinary symptoms, bone mineral density, sexual function and investigate the CAG repeats Length in LOH men. METHODS We reviewed the medical records of 428 men with a diagnosis of LOH and who had been treated with TU between January 2007 and December 2014. A total of 4 patients were diagnosed with prostate cancer during TU. There are 120 patients (mean age 65.6 ± 8.9) who had a minimum of 5 years continuous TU supplementation and sufficiently completed records to all analysis and a maximum duration of 8 years. The mean and median duration of treatment was 80.13 and 84 months, respectively. Men received intramuscular injections of 1,000 mg TU at day 1, at week 6, and every 10-14 weeks thereafter. Genomic DNA was extracted from peripheral blood and the CAG repeat region was amplified by PCR. Fragment analysis and sequencings was performed. We confirmed the results with electropherogram and chromatogram (gene scan). The main outcome measure was dynamic parameters changes in testosterone supplement. Statistical analysis were performed with the statistics programs Stata version 14.0 and SPSS11.5. RESULTS TU did not improve all obesity parameter. A statistically significant decline (p < 0.05) was found in waist circumference, % body fat, HbA1c, cholesterol, and LDL. TU did not produce differences in BMI, HDL, triglyceride and the Aging Male Symptoms (AMS) score from the base line. However, a statistically significant increase (p < 0.05) was demonstrated in the level of testosterone, PSA, hematocrit and International index of erectile function score. Both vertebral and femoral BMD was statistically significant increase (p < 0.05). No prostate cancer was reported in this group. The repeat length CAG was between 14-31. The most CAG length was median (20-23) with low testosterone. Men with longer CAG receptor had higher levels of total T and AMS score. There was no association between repeat length and any of the anthropometric measure. CONCLUSIONS Long-term TU treatment in LOH men for up to 8 years durations appears to be safe, tolerable and effective in improving obesity parameter. The results suggested the AR CAG repeat length correlates with serum Testosterone of aging men. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1011 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sompol Permpongkosol More articles by this author Kalayanee Khupulsup More articles by this author Supatra Leelaphiwat More articles by this author Sarawan Pavavattananusorn More articles by this author Tanoon Pettong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Plasma miRNA expression profile in the diagnosis of late-onset hypogonadism.

Researchers reporting in the Nature journal Scientific Reports1 have used next generation sequencing and quantitative reverse transcriptase PCR (RT-PCR) technology to profile plasma microRNA (miRNA) expression in cohorts of men with and without late-onset hypogonadism (LOH). The study proposes a panel of three miRNAs as novel biomarkers to aid in the diagnosis of LOH.

Hipogonadismo de inicio tardío: revisión de conceptos y pautas diagnósticas

Late-onset hypogonadism is a clinical and biochemical syndrome that is increasingly more frequent in the adult male population. However, it is rarely diagnosed and therefore goes untreated in the majority of affected men. The association between age-related testosterone deficiency and late-onset hypogonadism continues to be a subject of debate and its relation to symptoms such as loss of muscle strength and volume, loss of libido, erectile dysfunction, and changes in affective and emotional statuses of the patient are insidious, given that the symptomatology is often attributed to the “normal” aging process or other comorbidities of the patient. The diagnosis of late-onset hypogonadism is based on the coexistence of low total or free testosterone serum levels and symptoms suggestive of hypogonadism. Even though screening questionnaires directed at patients with clinical suspicion of the disease have been developed for late-onset hypogonadism, their diagnostic sensitivity and specificity is limited. Accurate and opportune diagnosis is vitally important because it enables testosterone levels to be reestablished and significant clinical improvement to be made through androgen replacement therapy.

Testosterone and benign prostatic hyperplasia.

The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.

A herbal medicine, saikokaryukotsuboreito, improves serum testosterone levels and affects sexual behavior in old male mice

Late-onset hypogonadism (LOH) is a clinical syndrome characterized with aging and declined serum testosterone levels. Sexual symptoms are also essential for the diagnosis of LOH. Testosterone replacement therapy is used widely to treat LOH. However, the side effects of it should not be ignored, such as fluid retention, hypertension and spermatogenic suppression. Therefore, alternate treatment modalities have been pursued. Herbal medicines used widely in China have achieved satisfying results with little side effects. Nonetheless, there are few pharmacological researches on them. In this study, 24-month-old mice were used as LOH animal models to explore the pharmacological effects of a herbal medicine, saikokaryukotsuboreito (SKRBT), on serum testosterone levels and sexual functions. Furthermore, the expression of steroidogenic acute regulatory (StAR) protein, a kind of rate-limiting enzyme of testosterone synthesis, was also examined. As a result, SKRBT improved the serum testosterone levels of these mice at a dose of 300 and 450 mg/kg. Multiple measures of sexual behavior were enhanced. The expression of StAR was also increased. Therefore, this study suggested that SKRBT can improve the serum testosterone levels by activating the expression of StAR and might be a viable option to treat sexual symptoms caused by LOH.

Late-onset hypogonadism: Current concepts and controversies of pathogenesis, diagnosis and treatment

Although suppressed serum testosterone (T) is common in ageing men, only a small proportion of them develop the genuine syndrome of low T associated with diffuse sexual (e.g., erectile dysfunction), physical (e.g. loss of vigor and frailty) and psychological (e.g., depression) symptoms. This syndrome carries many names, including male menopause or climacterium, andropause and partial androgen deficiency of the ageing male (PADAM). Late-onset hypogonadism (LOH) describes it best and is therefore generally preferred. The decrease of T in LOH is often marginal, and hypogonadism can be either due to primary testicular failure (low T, high luteinizing hormone (LH)) or secondary to a hypothalamic-pituitary failure (low T, low or inappropriately normal LH). The latter form is more common and it is usually associated with overweight/obesity or chronic diseases (e.g., type 2 diabetes mellitus, the metabolic syndrome, cardiovascular and chronic obstructive pulmonary disease, and frailty). A problem with the diagnosis of LOH is that often the symptoms (in 20%–40% of unselected men) and low circulating T (in 20% of men >70 years of age) do not coincide in the same individual. The European Male Ageing Study (EMAS) has recently defined the strict diagnostic criteria for LOH to include the simultaneous presence of reproducibly low serum T (total T <11 nmol l−1 and free T <220 pmol l−1) and three sexual symptoms (erectile dysfunction, and reduced frequency of sexual thoughts and morning erections). By these criteria, only 2% of 40- to 80-year-old men have LOH. In particular obesity, but also impaired general health, are more common causes of low T than chronological age per se. Evidence-based information whether, and how, LOH should be treated is sparse. The most logical approach is lifestyle modification, weight reduction and good treatment of comorbid diseases. T replacement is widely used for the treatment, but evidence-based information about its real benefits and short- and long-term risks, is not yet available. In this review, we will summarize the current concepts and controversies in the pathogenesis, diagnosis and treatment of LOH.

Testosteron im Alter – ein Update

Contrasting the relatively abrupt hormonal changes during female menopause, male reproductive function gradually declines during aging. This leads to the formal diagnosis of androgen deficiency in many apparently healthy 80-year-old men, when conventional thresholds are applied, and consequently to the question of androgen substitution in geriatric medicine. Although many clinical studies have documented a correlation between low plasma testosterone levels and mortality a clear causal relationship - which would imply immanent substitution therapy - has not been demonstrated. With this in mind, the diagnosis of late-onset hypogonadism (LOH) should only be made when testosterone-deficiency related symptoms concur with low testosterone levels. Which exact symptoms justify the diagnosis of LOH, however, is not sharply defined. Using criteria defined in the recent EMAS study, LOH might even be an over-diagnosed entity without huge relevance in geriatrics. Low testosterone levels are associated with frailty, but testosterone supplementation has only shown limited effects on age-related sarcopenia. Moreover: the increased incidence of cardiovascular events in the TOM study should be a caveat and lead to a moratorium for uncritical testosterone supplementation in aging men with cardiovascular diseases.

How to recognize late-onset hypogonadism in men with sexual dysfunction.

Late-onset hypogonadism (LOH) has been considered the most common form of male hypogonadism with a prevalence of approximately 1 in 100 men. Diagnosis of LOH should be made in symptomatic men with unequivocally low serum testosterone (T) levels. However, its clinical presentation is often insidious and difficult to recognize because it is characterized by nonspecific symptoms that make differential diagnosis with physiological ageing problematic. Sexual dysfunction is the most important determinant for medical consultation and the most specific symptom associated with low T. We therefore analysed a consecutive series of 1734 subjects who attended our unit for sexual dysfunction to investigate the associations between low T (different thresholds), sexual parameters, medical history data (delayed puberty, pituitary disease or cryptorchidism) and their physical exam results. Metabolic parameters, in particular waist circumference, display the greatest accuracy in detecting low T. We found that only the association of several symptoms and signs could significantly raise the clinical suspicion of low T. Structured inventories, which cluster together symptoms and signs of hypogonadism, can help clinicians suspect androgen deficiency. In particular, structured interviews, such as ANDROTEST, have been demonstrated to have a greater accuracy when compared to self reported questionnaires in detecting low T levels.

Survey for late-onset hypogonadism among old and middle-aged males in Shanghai communities

This study sought to investigate late-onset hypogonadism (LOH) in old and middle-aged males in Shanghai communities, using symptom score evaluation systems and measurements of sex hormone levels. One thousand cases of males aged 40-70 years were investigated. The aging male symptoms (AMS) scale and androgen deficiency in aging males (ADAM) questionnaire were used at the beginning of the investigation, followed by measurement of the sex hormone-related factors (total testosterone (TT), free testosterone (fT), sex hormone-binding globulin (SHBG) and bioavailability of testosterone (Bio-T)). There were 977 valid questionnaires. The LOH-positive rates shown by AMS and ADAM were 59.88% and 84.65%, respectively; values increased with the age of the patients. There were 946 results related to sex hormone measurements, which showed the following results: TT was not related to aging (P>0.05); levels of SHBG increased with age; and fT and Bio-T decreased with age. There was a significant difference in fT between LOH-positive and LOH-negative patients, as shown by the ADAM. In summary, TT levels were not related to aging, even though SHBG did increase while fT and Bio-T decreased with aging. Clinically, the diagnosis of LOH cannot be based on serum TT level.

Male late-onset hypogonadism: pathogenesis, diagnosis and treatment

Some aging men develop a condition of suppressed serum testosterone levels, which is associated with diffuse sexual, physical and psychological symptoms. Several terms are used for this syndrome, but late-onset hypogonadism (LOH) is preferred. The diagnosis of LOH is often uncertain because symptoms (occurring in 20-40% of men) and low circulating testosterone (found in 20% of men >70 years of age) seldom occur together. The strict diagnostic criteria for LOH include reproducibly low serum testosterone levels and sexual symptoms, including erectile dysfunction and reduced frequency of sexual thoughts and morning erections. Using these diagnostic criteria, only 2% of 40-80-year-old men have LOH. Obesity and impaired general health (including diabetes mellitus, cardiovascular and chronic obstructive pulmonary disease, and frailty) are more common reasons for low testosterone than advanced age per se. It seems logical, therefore, to begin by treating these conditions before testosterone replacement therapy is initiated. Even then, testosterone should only be used if there are no contraindications, such as unstable cardiac disease, serious prostate symptoms and high hemoglobin level. The long-term benefit of testosterone replacement therapy is uncertain, and the experimental nature of the treatment, and its associated risks, must be fully explained to the patient before treatment begins.

Identifying late-onset hypogonadism in older men

Late-onset hypogonadism (LOH) is frequently difficult to diagnose in middle-aged and elderly men. A recent study has reported that a cluster of three sexual symptoms and a total testosterone threshold of less than 11 nmol/l are important determinants for the diagnosis of LOH in this age group.