title: Adult-Onset Hypogonadism.
abstract: In August 2015, an expert colloquium commissioned by the Sexual Medicine Society of North America (SMSNA) convened in Washington, DC, to discuss the common clinical scenario of men who present with low testosterone (T) and associated signs and symptoms accompanied by low or normal gonadotropin levels. This syndrome is not classical primary (testicular failure) or secondary (pituitary or hypothalamic failure) hypogonadism because it may have elements of both presentations. The panel designated this syndrome adult-onset hypogonadism (AOH) because it occurs commonly in middle-age and older men. The SMSNA is a not-for-profit society established in 1994 to promote, encourage, and support the highest standards of practice, research, education, and ethics in the study of human sexual function and dysfunction. The panel consisted of 17 experts in men's health, sexual medicine, urology, endocrinology, and methodology. Participants declared potential conflicts of interest and were SMSNA members and nonmembers. The panel deliberated regarding a diagnostic process to document signs and symptoms of AOH, the rationale for T therapy, and a monitoring protocol for T-treated patients. The evaluation and management of hypogonadal syndromes have been addressed in recent publications (ie, the Endocrine Society, the American Urological Association, and the International Society for Sexual Medicine). The primary purpose of this document was to support health care professionals in the development of a deeper understanding of AOH, particularly in how it differs from classical primary and secondary hypogonadism, and to provide a conceptual framework to guide its diagnosis, treatment, and follow-up.
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Mohit
authors.initials: M
authors.lastname: Khera
authors.affiliation: Mayo Clinic College of Medicine, Department of Urology, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Broderick
authors.affiliation: University of North Carolina, Chapel Hill, NC.
authors.forename: Culley C
authors.initials: CC
authors.lastname: Carson
authors.affiliation: Department of Medicine, Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Dobs
authors.affiliation: Four Oaks Consulting, Inc, Berryville, VA.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Faraday
authors.affiliation: Alvarado Hospital, San Diego, CA.
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
authors.affiliation: Department of Urology, Cleveland Clinic Florida, Weston, FL.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Hakim
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA; Section of Andrology, Tulane University School of Medicine, New Orleans, LA; Tulane Medical Center, University Medical Center, and the Veteran's Affairs Medical Center, New Orleans, LA.
authors.forename: Wayne J G
authors.initials: WJ
authors.lastname: Hellstrom
authors.affiliation: Men's Health Boston, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Kacker
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Tobias S
authors.initials: TS
authors.lastname: Köhler
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA; The Men's Clinic at UCLA, Los Angeles, CA.
authors.forename: Jesse N
authors.initials: JN
authors.lastname: Mills
authors.affiliation: Men's Health Center, Providence, RI; Miriam Hospital, Providence, RI; Warren Alpert School of Medicine, Brown University, Providence, RI.
authors.forename: Martin
authors.initials: M
authors.lastname: Miner
authors.affiliation: Rutgers New Jersey Medical School and Hackensack University Medical Center, Hackensack, NJ.
authors.forename: Hossein
authors.initials: H
authors.lastname: Sadeghi-Nejad
authors.affiliation: Division of Urology, Cooper University Hospital, Camden, NJ; Cooper Medical School of Rowan University, Camden, NJ; MD Anderson Cancer Center, Houston, TX.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Seftel
authors.affiliation: Department of Urology, University of California, San Francisco, CA.
authors.forename: Ira D
authors.initials: ID
authors.lastname: Sharlip
authors.affiliation: Division of Endocrinology, Metabolism and Diabetes, University of Louisville, Louisville, KY.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Winters
authors.affiliation: Department of Urology, Oncology, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: info@smsna.org.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000375:Aging / Q000502:physiology; D000728:Androgens / Q000009:adverse effects / Q000172:deficiency / Q000627:therapeutic use; D015897:Comorbidity; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D013739:Testosterone / Q000009:adverse effects / Q000172:deficiency* / Q000627:therapeutic use
chemical_list: D000728:Androgens; D013739:Testosterone