Symptoms Of Late-onset Hypogonadism Research Articles

Clinical experience with Andriol® Testocaps®– The first Austrian surveillance study on the treatment of late-onset hypogonadism

Objective. The objective of this study was to document the efficacy and tolerability of the new formulation of Andriol® Testocaps® in the treatment of late-onset hypogonadism in a clinical practice setting.Methods. The primary inclusion criterion was symptomatic testosterone deficiency, as confirmed by laboratory testing (morning total testosterone <12 nmol/L) on two separate occasions. The study was performed in 43 centres in Austria and a dosage of oral testosterone undecanoate of 2×80 mg/day was used for three months. The ADAM questionnaire, the AMS scale and the SF-36 questionnaire were administered by the patients and specific questions were asked to the prescribers.Results. A total of 189 patient report forms and 185 doctor report forms were completed. The average age of the participants was 54.7 ± 12.3 years and average treatment duration was 13.9 ± 2.2 weeks. Serum testosterone level increased by more than 50% from 8.7 ± 4.3 nmol/L to 13.2 ± 6.7 nmol/L (p < 0.001). Treatment improved symptoms on the ADAM and AMS scales, whereas no changes were observed on the SF-36. There were no significant effects on serum PSA levels.Conclusion. Short-term treatment with oral testosterone undecanoate in a clinical practice setting improved late-onset hypogonadism symptoms in aging men with low testosterone levels.

Office-based assessment of the suspected hypogonadal male

Although age-related gonadal hormone changes have been extensively studied in women, testosterone deficiency is often overlooked and undertreated in men. However, declining testosterone in the aging male is attracting increased interest from the medical community and the public at large. In men, gonadal function is progressively declining as a part of the normal aging process. This phenomenon has been given many names: male climacteric, symptomatic late-onset hypogonadism, andropause, partial androgen deficiency of the aging male, or androgen decline in the aging male. Although andropause may be somewhat of a misnomer, it refers to the slow, steady decline of testosterone in men as they age. This decline may contribute to age-associated weakness, depression, fatigue, and loss of libido, as well as to the reduction of bone mass and lean muscle mass. The term andropause is now well recognized and identified by men and the public as a clinical entity. The article focuses on the office-based assessment of the suspected hypogonadal male.

Ageing male and testosterone: Current status and treatment guidelines

Because the decline in androgens is generally gradual and not a complete deficiency, clinical significance of this decline is still unclear, and there is controversy as to whether a specific syndrome of androgen deficiency or 'andropause' exists. The term andropause or androgen deficiency in aging males (ADAM) underwent revisions to, partial androgen deficiency in aging male (PADAM), late onset hypogonadism (LOH) and now symptomatic late onset hypogonadism (SLOH), signifying, the evolving nature of this phenomenon. Since this happens at a time of life, when many men have associated comorbities, it's difficult to assess the exact impact of androgen decline, due to which, the issues surrounding androgen replacement therapy in men with symptomatic late-onset hypogonadism have been marred in controversy. Although with age, a decline in testosterone levels will occur in virtually all men, there is no way of predicting, who, will experience andropausal symptoms of sufficient severity and also long-term safety data on testosterone administration in this setting, is lacking.<b> </b> This article will focus on the controversies and practices of androgen replacement.

Therapy of the Aging male

Serum testosterone levels decline in men with increasing age. Late-onset hypogonadism with its characteristic symptoms can occur in men as they age. Typical symptoms of late-onset hypogonadism are decreased libido and sexual function, osteoporosis, altered distribution of body fat, overall reduction in physical strength, and alterations in general mood. Late-onset hypogonadism can be treated with testosterone, and different forms of testosterone have become available for this indication. The aim of testosterone replacement therapy is to produce serum testosterone levels within the physiological range avoiding levels above and below this range. Although hormone replacement therapy has become accepted in aging males, careful consideration of the indications and therapy monitoring are still required since there are major concerns about the long-term outcome of this therapy and particularly its effects on the prostate gland.

Clomiphene Citrate Effects on Testosterone/Estrogen Ratio in Male Hypogonadism

Symptomatic late-onset hypogonadism is associated not only with a decline in serum testosterone, but also with a rise in serum estradiol. These endocrine changes negatively affect libido, sexual function, mood, behavior, lean body mass, and bone density. Currently, the most common treatment is exogenous testosterone therapy. This treatment can be associated with skin irritation, gynecomastia, nipple tenderness, testicular atrophy, and decline in sperm counts. In this study we investigated the efficacy of clomiphene citrate in the treatment of hypogonadism with the objectives of raising endogenous serum testosterone (T) and improving the testosterone/estrogen (T/E) ratio. Our cohort consisted of 36 Caucasian men with hypogonadism defined as serum testosterone level less than 300 ng/dL. Each patient was treated with a daily dose of 25 mg clomiphene citrate and followed prospectively. Analysis of baseline and follow-up serum levels of testosterone and estradiol levels were performed. The mean age was 39 years, and the mean pretreatment testosterone and estrogen levels were 247.6 +/- 39.8 ng/dL and 32.3 +/- 10.9, respectively. By the first follow-up visit (4-6 weeks), the mean testosterone level rose to 610.0 +/- 178.6 ng/dL (P < 0.00001). Moreover, the T/E ratio improved from 8.7 to 14.2 (P < 0.001). There were no side effects reported by the patients. Low dose clomiphene citrate is effective in elevating serum testosterone levels and improving the testosterone/estradiol ratio in men with hypogonadism. This therapy represents an alternative to testosterone therapy by stimulating the endogenous androgen production pathway.

The reliability of clinical and biochemical assessment in symptomatic late‐onset hypogonadism: can a case be made for a 3‐month therapeutic trial?

To assess whether testosterone (T) supplementation in men considered to have symptomatic late-onset hypogonadism (SLOH) can be evaluated clinically and biochemically. To assess the relevance of the clinical and biochemical diagnosis of hypogonadism we investigated patients referred for the diagnosis and treatment of SLOH. Patients were assessed clinically and completed a screening questionnaire. The pituitary-adrenal-gonadal axis was comprehensively assessed biochemically. Those with a clinical diagnosis of hypogonadism and serum levels of T supporting such a diagnosis received exogenous T for >/= 3 months and were assessed for any clinical and biochemical response. Of an initial group of 45 men (mean age 59.2 years) 38 completed the study. Most men presented with symptoms of sexual dysfunction, lack of energy and/or depression. There were differences before and after treatment only in bioavailable T (BT), with none in the levels of total T (TT). There was a strong correlation before and after treatment in the levels of luteinizing hormone and follicle-stimulating hormone, and a weak negative correlation between gonadotrophins and BT. Neither TT nor BT had predictive value for the treatment response. There was a trend to a correlation between BT levels and treatment success. Changes in serum prostate specific antigen were insignificant during the limited period. The lack of accurate methods for diagnosing SLOH suggests that a therapeutic trial of T supplementation is warranted in men in whom there are no contraindications. The 3-month period largely circumvents the placebo effect and has minimal risks for serious adverse effects (mostly in relation to prostate safety). This controversial position needs further evaluation with a larger cohort and other biochemical measurements.

Testosterone treatment for the aging man: The controversy

The issues surrounding androgen replacement therapy in men with symptomatic late-onset hypogonadism has been marred in controversy even before the identification and synthesis of testosterone. The controversy has attained renewed importance because of the ever increasing aging population. Physicians attuned with the various diagnostic approaches, familiar with the advantages and drawbacks of testosterone preparations, and aware of the potential safety issues are well positioned to deal with the hypogonadal man at or beyond middle age. The urologist is in a unique position to assist patients and colleagues in other specialties, particularly in relation to prostate safety. This update focuses on the most prominent areas of controversy.

Andropause (or symptomatic late-onset hypogonadism): facts, fiction and controversies

The existence of the so-called 'andropause' is an irrefutable fact, although the terms 'SLOH' (symptomatic late-onset hypogonadism) or 'symptomatic ADAM' (androgen deficiency of the aging male) are more accurate. The term 'andropause' is, in most cases, inappropriate, except when the gonads cease functioning. Testosterone production decreases as a function of age, but this decrease is not universal. Several clinical manifestations are associated with hypogonadism, but these are not solely attributable to hypogonadism. Other hormones (i.e. dehydroepiandrosterone, growth hormone, thyroxine and melatonin) also decrease with age. Such multi-hormone alterations are closely inter-related and may influence 'andropause-related' symptoms. Many patients with SLOH, although by no means all, respond well to testosterone therapy. Although testosterone therapy can induce adverse effects, these can be largely minimized by proper monitoring by a knowledgeable clinician. Extrapolation of the effects of estrogens + progesterone in menopausal women to the use of testosterone in hypogonadal men is mythical, and more research on the effect of exogenous sex steroids in aging men and women is needed. However, to restrict the prescription of such hormones until all issues have been fully addressed is impossible. Indeed, the discourse on SLOH would benefit considerably from more science and less speculation.