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Late-Onset Hypogonadism

A clinical and biochemical syndrome in men due to age-related decline in testosterone levels.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Late-Onset Hypogonadism?

Late-onset hypogonadism (LOH) is a decrease in serum testosterone to clinically symptomatic levels in men due to age-related decline in Leydig cell function and disruption of the hypothalamic-pituitary-gonadal axis. It is also called 'andropause' or 'male menopause.'

Testosterone declines with age in every man, but the clinical picture varies widely between individuals. Obesity, type 2 diabetes, metabolic syndrome, and chronic illnesses increase the risk and severity of LOH.

Morning total testosterone measurement (at least two separate measurements) and symptom assessment (AMS or ADAM questionnaire) are required for diagnosis. Before deciding on testosterone replacement, prostate cancer, polycythemia, and obstructive sleep apnea must be assessed.

Symptoms

Decreased libido and sexual interest
Erectile dysfunction
Fatigue, low energy, and apathy
Decrease in muscle mass and strength
Abdominal fat accumulation
Depression, irritability, and difficulty concentrating
Decreased bone density

Risk Factors

Older age (>50 years)
Obesity and metabolic syndrome
Type 2 diabetes
Chronic illnesses (COPD, renal failure, liver disease)
Use of opioids or corticosteroids
Sleep apnea

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Loss of libido, fatigue, and muscle weakness coexisting in a middle-aged or older man
  • Erectile dysfunction warranting hormone evaluation
  • When low testosterone level is detected
  • When low testosterone contribution to osteoporosis is being investigated

Treatment Methods

01
Lifestyle: weight loss, exercise, and improved sleep quality (contribute to testosterone increase)
02
Testosterone replacement therapy (TRT): gel, injection, or transdermal forms
03
Before starting TRT, baseline PSA and hematocrit are measured
04
Hematocrit, PSA, and clinical response are evaluated every 3-6 months during TRT
05
Active prostate cancer, hematocrit >54%, high cardiovascular risk: contraindication or careful evaluation for TRT
06
Clomiphene citrate or gonadotropins may be options when fertility preservation is desired

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.