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Volume 14, Issue 2 (March 2012) 14, 251–259; 10.1038/aja.2011.138

How to recognize late-onset hypogonadism in men with sexual dysfunction

Giovanni Corona1,2, Giulia Rastrelli1, Linda Vignozzi1, Edoardo Mannucci3 and Mario Maggi1

1 Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence 50139, Italy
2 Endocrinology Unit, Maggiore-Bellaria Hospital, Medical Department, Azienda-Usl Bologna, Bologna 40133, Italy
3 Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence 50139, Italy

Correspondence: Professor M Maggi, (m.maggi@dfc.unifi.it)

Received 30 June 2011; Revised 31 July 2011; Accepted 11 August 2011; Advance online publication 30 January 2012


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.

Keywords: late-onset hypogonadism (LOH); male hypogonadism; testosterone; sexual dysfunction

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