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.

Adult-onset hypogonadism: evaluation and role of testosterone replacement therapy

“…The Sexual Medicine Society of North America defines adult-onset hypogonadism (AOH) as a clinical and biochemical syndrome characterized by a deficiency of testosterone with associated signs and symptoms and a failure of the body to produce an adequate compensatory response (1). AOH can be caused by testicular and/or hypothalamic-pituitary dysfunction, making it clinically distinct from primary and secondary hypogonadism.…”

Impact of recent FDA ruling on testosterone replacement therapy (TRT)

“…It is characterized by testosterone deficiency and low to normal gonadotropin levels due to hyposecretion of both the testis and pituitary. These men are unable to mount an adequate compensatory central response (9). This is in contrast to classical hypogonadism comprised of (I) primary hypogonadism with testicular dysfunction and (II) secondary hypogonadism due to central dysfunction.…”

“…This is in contrast to classical hypogonadism comprised of (I) primary hypogonadism with testicular dysfunction and (II) secondary hypogonadism due to central dysfunction. The Sexual Medicine Society of North America (SMSNA) recently acknowledged that 70% of men with AOH presenting with low gonadotropin levels have associated comorbid metabolic disease including diabetes, obesity and metabolic syndrome (9). This issue may be under-addressed in practice even though the Endocrine Society recommends screening diabetic men (3).…”

Prevalence of Adult-Onset Hypogonadism and Erectile Dysfunction in Males with Prediabetes

“…This syndrome is characterized by testosterone deficiency and the failure to mount an adequate compensatory pituitary response to low testosterone levels; gonadotropin levels are low or in the normal range. AOH is, therefore, clinically distinct from classical primary and secondary hypogonadism [6]. Erectile dysfunction (ED) may be caused by endocrine, vascular, neurological, and psychological disorders and may also be a side effect of drugs.…”