Serum testosterone levels in male hypogonadism: Why and when to check-A review

Abstract

SummaryAimAlthough “late onset hypogonadism”, a condition that includes low testosterone and symptoms, is common in men over the age of 40 years, diagnosis is not clear cut amongst non‐specialists. It is the aim of this review to provide an up to date picture of how this state should be diagnosed and managed.MethodsWe aim to describe how primary and secondary hypogonadism should be excluded before the diagnosis of late onset hypogonadism is reached. As laboratory testosterone measurements are essential the current pitfalls such as inappropriate sample collection and the use of population derived reference ranges are expanded. We review current evidence to determine associations between late onset hypogonadism and morbidity/mortality and benefits following testosterone replacement therapy.ResultsA review of the current evidence shows that late onset hypogonadism is associated with a worse metabolic state and increased mortality. Longitudinal studies have suggested that significant reductions in both symptoms and mortality are seen, especially in patients with type 2 diabetes.DiscussionThis review highlights the importance of diagnosing late onset hypogonadism due to its association with morbidity/mortality and benefits following testosterone replacement. Thus, after making recommendations to ensure correct diagnosis we speculate whether the time has come to move away from population derived testosterone levels towards evidence based action limits.

A new 2% testosterone gel formulation: a comparison with currently available topical preparations

“…Although serum‐free testosterone levels seem to be a reliable measure of testosterone concentration (Livingston et al ., ), special care should be taken in patients presenting with comorbid conditions like HIV, liver cirrhosis and visceral obesity (Livingston et al ., ). In such patients, both free and bioavailable testosterone should be evaluated, as the individual variation in SHBG concentrations may influence total testosterone levels (Lunenfeld et al ., ).…”

Secular trends in testosterone- findings from a large state-mandate care provider

“…Other comorbid conditions which have be associated with low serum testosterone, include heart failure, osteoporosis, dyslipidemia, and type 2 diabetes [11]. While the prevalence of these chronic diseases has been increasing over recent decades, it is unlikely to explain increased rate of hypogonadism across all age groups as indicated by our results.…”

Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics

“…Testosterone deficiency (TD), characterised by low testosterone levels and related symptoms, occurs in 6-12% of men [1,2]. TD is associated with decreased bone [3,4]. Prevalence of adult onset TD in men with T2DM is about 40% [5,6].…”

“…mineral density, lean mass, muscle strength, cognitive function, sexual function and increased fat mass[1,2,3]. The phenotype is categorised as primary TD, secondary TD (pituitary/hypothalamic disease) or adult onset TD.…”