How to recognize late-onset hypogonadism in men with sexual dysfunction.

Late-onset hypogonadism (LOH) has been considered the most common form of male hypogonadism with a prevalence of approximately 1 in 100 men. Diagnosis of LOH should be made in symptomatic men with unequivocally low serum testosterone (T) levels. However, its clinical presentation is often insidious and difficult to recognize because it is characterized by nonspecific symptoms that make differential diagnosis with physiological ageing problematic. Sexual dysfunction is the most important determinantformedicalconsultationandthemostspecificsymptomassociatedwithlowT.Wethereforeanalysedaconsecutiveseries of 1734 subjects who attended our unit for sexual dysfunction to investigate the associations between low T (different thresholds), sexual parameters, medical history data (delayed puberty, pituitary disease or cryptorchidism) and their physical exam results. Metabolic parameters, in particular waist circumference, display the greatest accuracy in detecting low T. We found that only the associationofseveralsymptomsandsignscouldsignificantlyraisetheclinicalsuspicionoflowT.Structuredinventories,whichcluster together symptoms and signs of hypogonadism, can help clinicians suspect androgen deficiency. In particular, structured interviews, suchasANDROTEST,havebeendemonstratedtohaveagreateraccuracywhencomparedtoselfreportedquestionnairesindetecting low T levels.