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8 June 2011

Evidence-based criteria identifying late-onset hypogonadism defined

Image: Sleeping man

Identification of late-onset hypogonadism in middle-aged and elderly men. Wu FC, Tajar A, Beynon JM, et al. N Engl J Med 2010;363(2):123-135.

This was a systematic investigation of a random population sample of 3369 middle-aged and elderly men (aged 40–79 years) to establish 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. The men surveyed were participating in the European Male Aging Study (EMAS) at eight European centers. Data were collected on the men’s general, sexual, physical, and psychological health, and total testosterone levels were measured in morning blood samples and free testosterone levels were calculated. Data were randomly split into separate training and validation sets for confirmatory analyses.

A total of 32 items were considered as possible candidates for symptoms of androgen deficiency on the basis of previous recommendations and studies; all items were then screened statistically and those that were significantly associated with total or free testosterone levels were selected for independent validation and further divided into symptomatic and asymptomatic categories. The findings were published in the New England Journal of Medicine.

Key Points

Nine symptoms were confirmed to be significantly related to total or freetestosterone (T) level

  • Three sexual symptoms
  • Three physical symptoms
  • Three psychological symptoms
  • The probability of symptoms increased with decreased levels of T and the presence of the three sexual symptoms correlated most closely with low T
  • Total T <317 ng/dL (11 nmol/L) + free T levels <64 pg/mL (220 pmol/L) + all 3 sexual symptoms were diagnostic of late-onset hypogonadism.

8 June 2011

Evidence-based criteria for diagnosing low testosterone in aging men defined

Image: Sleeping man

This study, published in the New England Journal of Medicine, identified the most important symptoms linked to late-onset hypogonadism (low testosterone levels in aging men) in a large group of men representative of the general population. When testosterone levels were also taken into consideration, having these three symptoms and low testosterone levels was a specific diagnosis of late-onset hypogonadism.

Last updated: 2019