title: How to recognize late-onset hypogonadism in men with sexual dysfunction.
abstract: Late-onset hypogonadism (LOH) has been considered the most common form of male hypogonadism with a prevalence of approximately 1 in 100 men. Diagnosis of LOH should be made in symptomatic men with unequivocally low serum testosterone (T) levels. However, its clinical presentation is often insidious and difficult to recognize because it is characterized by nonspecific symptoms that make differential diagnosis with physiological ageing problematic. Sexual dysfunction is the most important determinant for medical consultation and the most specific symptom associated with low T. We therefore analysed a consecutive series of 1734 subjects who attended our unit for sexual dysfunction to investigate the associations between low T (different thresholds), sexual parameters, medical history data (delayed puberty, pituitary disease or cryptorchidism) and their physical exam results. Metabolic parameters, in particular waist circumference, display the greatest accuracy in detecting low T. We found that only the association of several symptoms and signs could significantly raise the clinical suspicion of low T. Structured inventories, which cluster together symptoms and signs of hypogonadism, can help clinicians suspect androgen deficiency. In particular, structured interviews, such as ANDROTEST, have been demonstrated to have a greater accuracy when compared to self reported questionnaires in detecting low T levels.
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence 50139, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Giulia
authors.initials: G
authors.lastname: Rastrelli
authors.forename: Linda
authors.initials: L
authors.lastname: Vignozzi
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D017668:Age of Onset; D000375:Aging / Q000097:blood / Q000473:pathology; D015897:Comorbidity; D003937:Diagnosis, Differential; D006801:Humans; D007006:Hypogonadism / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D009845:Oligospermia / Q000473:pathology; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D013739:Testosterone / Q000097:blood / Q000172:deficiency
chemical_list: D013739:Testosterone