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Volume 23, Issue 2 (March 2021) 23, 170–177; 10.4103/aja.aja_59_20

Prevalence of late-onset hypogonadism among middle-aged and elderly males in China: results from a national survey

Yi-Jun Liu1, Xu-Bo Shen1, Na Yu2, Xue-Jun Shang3, Yi-Qun Gu4, Lian-Dong Zuo5, Cheng-Liang Xiong6, Zhen Ye7, Yuan-Zhong Zhou7

1 School of Public Health, Zunyi Medical University, Zunyi 563000, China
2 Scientific Research Center, The Third Affiliated Hospital of Guang Dong Medical University (Long Jiang Hospital of Shunde District Foshan City), Foshan 528318, China
3 Department of Andrology, Eastern Theater General Hospital, Nanjing 210002, China
4 Institute of Science and Technology, National Research Institute for Family Planning, Beijing 100081, China
5 Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510632, China
6 Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
7 Department of Urology and Andrology, Wuhan Tongji Reproductive Medicine Hospital, Wuhan 430013, China

Correspondence: Dr. YZ Zhou (zhouyuanzhong@163.com) or Dr. Z Ye (846880106@qq.com)

Date of Submission 15-Feb-2020 Date of Acceptance 11-Aug-2020 Date of Web Publication 03-Nov-2020


This study aimed to propose an operational definition of late-onset hypogonadism (LOH) that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China. A population-based sample of 6296 men aged 40 years–79 years old was enrolled from six representative provinces in China. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were measured and free testosterone (cFT) was calculated. The Aging Males' Symptoms (AMS) scale was used to evaluate the LOH symptoms. Finally, 5078 men were included in this analysis. The TT levels did not decrease with age (P = 0.59), and had no relationship with AMS symptoms (P = 0.87 for AMS total score, P = 0.74 for ≥ 3 sexual symptoms). The cFT levels decreased significantly with age (P < 0.01) and showed a negative association with the presence of ≥ 3 sexual symptoms (P = 0.03). The overall estimated prevalence of LOH was 7.8% (395/5078) if a cFT level <210 pmol l−1 combined with the presence of ≥ 3 sexual symptoms was used as the criterion of LOH. Among them, 26.1% (103/395) and 73.9% (292/395) had primary and secondary hypogonadism, respectively. After adjustment for confounding factors, primary and secondary hypogonadism was positively related to age and comorbidities. Body mass index was an independent risk factor for secondary hypogonadism. The results suggest that the AMS total score is not an appropriate indicator for decreased testosterone, and that the cFT level is more reliable than TT for LOH diagnosis. Secondary hypogonadism is the most common form of LOH.

Keywords: Aging Males' Symptoms; calculated free testosterone; late-onset hypogonadism; middle-aged and elderly male; total testosterone

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