Title: Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men
Authors: Wu, Frederick C W ×
Tajar, Abdelouahid
Beynon, Jennifer M
Pye, Stephen R
Silman, Alan J
Finn, Joseph D
O'Neill, Terence W
Bartfai, Gyorgy
Casanueva, Felipe F
Forti, Gianni
Giwercman, Aleksander
Kula, Krzysztof
Lean, Michael E J
Pendleton, Neil
Punab, Margus
Boonen, Steven
Vanderschueren, Dirk
Labrie, Fernand
Huhtaniemi, Ilpo T #
Issue Date: Jun-2010
Series Title: New England Journal of Medicine vol:363 issue:2 pages:123-135
Abstract: BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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). Copyright 2010 Massachusetts Medical Society.
ISSN: 0028-4793
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Clinical and Experimental Endocrinology
Gerontology and Geriatrics
× corresponding author
# (joint) last author

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