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

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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.

Key Findings

Three sexual symptoms were most related to low testosterone levels:

  • reduced frequency of morning erection
  • reduced frequency of sexual thoughts (sex drive), and
  • erectile dysfunction (the inability to achieve or sustain an erection long enough for satisfactory sexual performance)

These symptoms together with blood tests showing low testosterone levels confirmed a diagnosis of late-onset hypogonadism.

Other physical or psychological symptoms that were linked to late-onset hypogonadism included:

  • not being able to do vigorous activity, such as running or lifting heavy objects
  • not being able to walk more than 1 km
  • not being able to bend, kneel or stoop
  • loss of energy
  • sadness
  • fatigue.

However, these non-sexual symptoms were only weakly related to low testosterone.

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

Background information

A large number of signs and symptoms possibly linked to low testosterone have been suggested to help doctors reach a diagnosis of hypogonadism. However, in older men it is often challenging to separate out symptoms actually linked to low testosterone from symptoms that may be non-specific or caused by other underlying health conditions. This has made it difficult to know whether a man is likely to benefit from testosterone replacement therapy or if his symptoms are just part of the ‘normal’ aging process.

This problem was tackled by researchers at the University of Manchester, who worked with European partners to ask 3.369 men between the ages of 40 and 79 years in eight European centres details about their sexual, physical and psychological health. They also measured their testosterone levels.

The team started with 32 candidate symptoms and found that only nine were actually linked to low testosterone levels. The three sexual symptoms were the most important of these. Additional symptoms often thought to be associated with late-onset hypogonadism (sometimes incorrectly called the ‘male menopause’) were able to be discounted, including changes in sleeping pattern, poor concentration, feeling worthless, nervousness or anxiety and difficulty getting up from a chair.

The study is important, as it provides good evidence that having all three sexual symptoms, together with low testosterone levels, correctly establishes a diagnosis of late-onset hypogonadism.