Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men

Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
New England Journal of Medicine (Impact Factor: 55.87). 07/2010; 363(2):123-35. DOI: 10.1056/NEJMoa0911101
Source: PubMed


The association between aging-related testosterone deficiency and late-onset hypogonadism in men remains a controversial concept. We sought evidence-based criteria for identifying late-onset hypogonadism in the general population on the basis of an association between symptoms and a low testosterone level.
We surveyed a random population sample of 3369 men between the ages of 40 and 79 years at eight European centers. Using questionnaires, we collected data with regard to the subjects' general, sexual, physical, and psychological health. Levels of total testosterone were measured in morning blood samples by mass spectrometry, and free testosterone levels were calculated with the use of Vermeulen's formula. Data were randomly split into separate training and validation sets for confirmatory analyses.
In the training set, symptoms of poor morning erection, low sexual desire, erectile dysfunction, inability to perform vigorous activity, depression, and fatigue were significantly related to the testosterone level. Increased probabilities of the three sexual symptoms and limited physical vigor were discernible with decreased testosterone levels (ranges, 8.0 to 13.0 nmol per liter [2.3 to 3.7 ng per milliliter] for total testosterone and 160 to 280 pmol per liter [46 to 81 pg per milliliter] for free testosterone). However, only the three sexual symptoms had a syndromic association with decreased testosterone levels. An inverse relationship between an increasing number of sexual symptoms and a decreasing testosterone level was observed. These relationships were independently confirmed in the validation set, in which the strengths of the association between symptoms and low testosterone levels determined the minimum criteria necessary to identify late-onset hypogonadism.
Late-onset hypogonadism can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter).

Download full-text


Available from: Margus Punab, Oct 05, 2015
195 Reads
    • "The association between T deficiency and poor health status, in fact, has been recently described in men with obesity (Corona et al., 2011d) or with a history of previous CV diseases and hypogonadism resulted to be protective on further CV events (Corona et al., 2014a). An increasing body of evidence suggests that a low T syndrome is common especially in older frail men with multiple morbidities (Travison et al., 2007; Wu et al., 2010) and that the lowering of circulating T might be a protective mechanism in unhealthy conditions (Corona et al., 2011d, 2014a). This adaptive mechanism might avoid physiological conditions of high-energy expenditure that are potentially detrimental for the sick patient (e.g., reproductive behavior, vigorous physical activity, increased energy expenditure, and high CV rate), thus conferring advantage for both the patient (in terms of sparing energy) and the species (preventing fatherhood) (Corona et al., 2011d, 2014a; Rochira & Guaraldi, 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Men with human immunodeficiency virus (HIV) infection are often hypogonadal and develop several HIV-associated non-acquired immunodeficiency syndrome (AIDS) (HANA) conditions that impair overall health status. No studies explored the relationship between health status and serum testosterone (T) in HIV-infected men. This study aims to investigate the association between total serum T and HANA, multimorbidity, and frailty in a large cohort of 1359 HIV-infected men and to explore the relationship between patients' overall health status and serum T. Among biochemical and hormonal measurement performed the main are serum total T, free triiodothyronine (fT3), and luteinizing hormone. Other outcome measurements include anthropometry, assessment of comorbidities and disabilities, overall health status defined as the number of HANA and by the 38-item multimorbidity frailty index, anthropometry, and bone mineral density. The cumulative relative risk of comorbidities is increased in HIV-infected men with hypogonadism (p < 0.001) and hypogonadism is associated with several comorbidities. The prevalence of hypogonadism increases progressively with the increase of the number of comorbidities. Frailty index is inversely related to serum total T (age-adjusted r = 0.298, r(2) = 0.089, p < 0.0001). Serum fT3 levels are significantly lower in hypogonadal than eugonadal men (p = 0.022). This suggests that low serum T could be considered a sensitive marker of frailty and poor health status and that the latter might induce hypogonadism. The more HIV-infected men are frail the more they are hypogonadal. This suggests that hypogonadism might be a naturally occurring condition in unhealthy HIV-infected men and raises concern about the safety of T treatment. In conclusion, low serum T is associated with multimorbidity, HANA, and frailty in HIV-infected men and this association seems to be bidirectional. Given the wide attitude to offer T treatment to HIV-infected men, caution is needed when prescribing T to HIV-infected male patients, especially if the patient is unhealthy or frail. © 2015 American Society of Andrology and European Academy of Andrology.
    Andrology 02/2015; 3(2). DOI:10.1111/andr.310 · 2.30 Impact Factor
  • Source
    • "These can affect bones, muscles , and lipids, as well as cognitive function Testosterone Deficiency Syndrome (TDS) or Late Onset Hypogonadism which is defined on the basis of clinical symptoms associated with abnormal testosterone levels. The European Male Aging Study [3] (EMAS) studied 3369 men aged 40−79 at 8 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Low levels of testosterone are manifested by erectile dysfunction, reduced sexual desire, and loss of morning erections with increasing numbers of men are being diagnosed and require treatment. The prevalence rates of testosterone deficiency vary according to different studies but may be as high as 40% in populations of patients with type 2 diabetes. There is increasing evidence that testosterone deficiency is associated with increased cardiovascular and all-cause mortality. Screening for low testosterone is recommended in a number of high risk groups including those with type 2 diabetes and metabolic syndrome. There are recent data to suggest that testosterone replacement therapy may reduce cardiovascular mortality as well as improving multiple surrogate markers for cardiovascular events. Specific clinical trials of testosterone replacement therapy are needed in selected populations but in the meantime we must treat patients based on the best current evidence.
    International Journal of Endocrinology 04/2014; 2014:143763. DOI:10.1155/2014/143763 · 1.95 Impact Factor
  • Source
    • "Others have reported a prevalence of 22% [44] and 69% [45], which is higher than age-related hypogonadism. Indeed, total testosterone levels less than 320 ng/dL were found in 17% of patients aged between 40 and 79 years [46], and free testosterone levels less than 6.5 ng/dL were found in 32% of patients aged between 73 and 78 years [47]. In contrast to age-related hypogonadism, lower testosterone plasma concentrations in COPD are mostly associated with a decrease in luteinizing hormone (LH) and follicle stimulating hormone (FSH) hypophysis secretion [43, 48]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to increase in future decades. Androgenopenia is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies have shown that androgen substitution could improve muscle mass in COPD patients, but alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation which is the reference therapy of COPD-associated undernutrition.
    02/2014; 2014:248420. DOI:10.1155/2014/248420
Show more