New recommendations by scientific societies about late-onset hypogonadism

LOH is a clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and a deficiency in serum testosterone levels.

Late-onset hypogonadism (LOH) is caused by a decline in gonadal production of androgens in males that occurs with aging. Data indicate that a significant percentage of men over age 60 have serum testosterone levels that are below the lower limits of young adult men (i.e., those age 20–30 yr). Sexual dysfunction—including erectile dysfunction (ED), decreased libido, difficulty achieving orgasm, and decreased penile sensation—is usually the presenting complaint, although fatigue, depressed mood, and decreased muscle mass are other common symptoms.

Because demographic data demonstrate that the percentage of the population in older age groups is increasing worldwide, LOH is becoming a topic of increasing interest and debate throughout the world.

The past decade has brought evidence that androgen treatment benefits hypogonadal men, and recent studies show short-term beneficial effects of testosterone in older men that are similar to those in younger men.

In view of the growing interest from practitioners in the testosterone treatment of older men, the International Society of Andrology (ISA), the International Society for the Study of the Aging Male (ISSAM), the European Association of Urology (EAU), the European Academy of Andrology (EAA), and the American Society of Andrology (ASA) convened meetings of a writing group with expert representatives from each of the societies. They met in Tampa, Florida, in 2008 to revise the recommendations on the “Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism” originally published by the ISA, ISSAM, and EAU in 2005.

The current recommendations provide updated evidence-based information for clinicians who diagnose and treat patients with LOH. These guidelines are available in the January 2009 issue of European Urology.