Late Onset Hypogonadism [LOH]. Current Concepts and Controversies - A Review

Male hypogonadism is a clinical syndrome complex, which includes symptoms-with or without signs and biochemical evidence of testosterone deficiency. Lower serum testosterone (T) is common in ageing men, but only a small proportion of them develop the syndrome of low T with diffuse sexual physical and psychological symptoms. This syndrome is not classical primary (testicular failure) or secondary (pituitary or hypothalamic failure) hypogonadism because it may have elements of both presentations. This syndrome is also known as male menopause or climacterium, andropause and partial androgen deficiency of the ageing male (PADAM). Late onset hypogonadism (LOH) describes it best and is therefore the preferred term. A problem with the diagnosis is that often the symptoms of hypogonadism and low circulating T do not coincide in the same individual. The European Male Ageing Study (EMAS) has suggested a strict diagnostic criterion for LOH that includes the simultaneous presence of low serum T and three sexual symptoms (erectile dysfunction, and reduced libido and morning erections). By these criteria, only 2% of 40 to 80 year old men have LOH. Evidence based information on treatment is limited. The easiest approach is lifestyle modification, weight reduction and good treatment of comorbid diseases. T replacement is also widely used as a treatment modality, but evidence-based information about its benefits and short and long term risks, is not yet available. In this review, we will summarize the current concepts and controversies in the pathogenesis, diagnosis and treatment of LOH.