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Strict Diagnostic Criteria Define Late-Onset Hypogonadism

Definition including low testosterone, sexual symptoms can guide use of testosterone therapy

WEDNESDAY, June 16 (HealthDay News) -- Using a concise definition of late-onset hypogonadism which includes the presence of specific sexual symptoms as well as a strict laboratory testosterone level cut-point in older men can identify those men who truly need testosterone replacement therapy, according to research published online June 16 in the New England Journal of Medicine.

Frederick C.W. Wu, M.D., of the University of Manchester in the United Kingdom, and colleagues conducted a survey of 3,369 men aged 40 to 79 which included questionnaires regarding sexual, physical, and psychological health, and also measured free and total testosterone levels. The collected data were split into two sets: an initial training data-set and a second validation set for confirmatory analyses.

The training data-set identified three sexual symptoms (poor morning erection, erectile dysfunction, and low desire), an inability to perform vigorous physical activity, fatigue, and depression as being significantly related to testosterone level. With decreasing free and total testosterone levels, the researchers found there was an increasing probability of having the three sexual symptoms and limited physical vigor, but only the presence of the three sexual symptoms was associated with low testosterone levels in a syndromic fashion. The validation data-set confirmed the association of the sexual symptoms with low testosterone levels, and the strengths of the association were used to determine that the minimal criteria for diagnosing late-onset hypogonadism was the presence of the three sexual symptoms in addition to a total testosterone level of less than 11 nmol per liter and a free testosterone level of less than 220 pmol per liter.

"Our results also highlight the substantial overlap between late-onset hypogonadism and nonspecific symptoms of aging. The application of these new criteria can guard against the excessive diagnosis of hypogonadism and curb the injudicious use of testosterone therapy in older men," the authors write.

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