Abstract
Late onset hypogonadism is becoming a more relevant topic because of the aging population, and many older patients are questioning their physicians about treatment for symptoms of declining testosterone. Low testosterone is present in 6% to 12% of the US adult male population and has several known etiologies. The clinician needs to be able to recognize the signs and symptoms of hypogonadism and initiate an appropriate workup. Historically, assays measuring serum testosterone levels have been difficult to interpret for many reasons. This article aims to provide the physician with basic directions for interpreting testosterone test results and to create an algorithm for determining which patients are candidates for hormone replacement therapy.
Similar content being viewed by others
References and Recommended Reading
Arujulo AB, O’Donnell AB, Brambilla DJ, et al.: Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts male aging study. J Clin Endocrinol Metab 2004, 89:5920–5926.
Tenover JL: The androgen-deficient aging male: current treatment options. Rev Urol 2003, 5(Suppl 1):S22–S28.
Hellstrom WJG, ed.: The Handbook of Sexual Dysfunction. Lawrence: American Society of Andrology; 1999.
Keenan DM, Veldhuis JD: Disruption of the hypothalamic luteinizing hormone pulsing mechanism in aging men. Am J Physiol Regul Integr Comp Physiol 2001, 281:R1917–R1924.
Porst H, Buvat J, eds.: Standard Practice in Sexual Medicine. Malden: Blackwell; 2006.
Swerdloff RS, Wang C: Androgen deficiency and aging in men. West J Med 1993, 159:579–585.
Rosner W, Auchus RJ, Azziz R, et al.: Utility, limitations and pitfalls in measuring testosterone: an Endocrine Society Position Statement. J Clin Endocrinol Metab 2006, Epub ahead of print.
Nieschlag E, Swerdloff R, Behre HM, et al.: Investigation, treatment and monitoring of late-onset hypogonadism in males. ISA, ISSAM, and EAU Recommendations. Eur Urol 2005, 48:1–4.
Larsen PR, ed.: Williams Textbook of Endocrinology, edn 10. Philadelphia: Saunders; 2003.
Kelleher S, Conway AJ, Handelsman DJ: Blood testosterone threshold for androgen deficiency symptoms. J Clin Endocrinol Metab 2004, 89:3813–3817.
Mikhail N: Does testosterone have a role in erectile function? Am J Med 2006, 119:373–382.
Christ-Crain M, Meier C, Huber P, et al.: Comparison of different methods for the measurement of serum testosterone in the aging male. Swiss Med Wkly 2004, 134:193–197.
Vermeulen A: Hormonal cut-offs of partial androgen deficiency: a survey of androgen assays. J Endocrinol Invest 2005, 28(3 Suppl):28–31.
Wang C, Catlin DH, Demers LM, et al.: Measurement of total serum testosterone in adult men: comparison of current laboratory methods versus liquid chromatographytandem mass spectrometry. J Clin Endocrinol Metab 2004, 89:534–543.
Vermeulen A, Verndonck L, Kaufman A: A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999, 84:3666–3672.
Rosner W: An extraordinarily inaccurate assay for free testosterone is still with us. J Clin Endocrinol Metab 2001, 86:2903.
Miller KK, Rosner W, Lee H, et al.: Measurement of free testosterone in normal women and women with androgen deficiency: comparison of methods. J Clin Endocrinol Metab 2004, 89:525–533.
Grant NN, Anawalt BD: Male hypogonadism in the primary care clinic. Prim Care Clin Office Pract 2003, 30:743–763.
Kaufman JM, Vermeulen A: The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev 2005, 26:833–876.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spencer Krane, L., Bowen, A.B. & Hellstrom, W.J.G. Controversies in the laboratory evaluation of hypogonadism: Androgen deficiency algorithm. Curr sex health rep 4, 51–55 (2007). https://doi.org/10.1007/s11930-007-0002-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11930-007-0002-5