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Cited by 88Hormonal and reproductive studiesMenopause: Health Impacts and TreatmentsHypothalamic control of reproductive hormones

Male late-onset hypogonadism: pathogenesis, diagnosis and treatment

Huhtaniemi, Ilpo, Forti, Gianni·2011·Nature Reviews Urology
DOI 10.1038/nrurol.2011.47
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Abstract

Some aging men develop a condition of suppressed serum testosterone levels, which is associated with diffuse sexual, physical and psychological symptoms. Several terms are used for this syndrome, but late-onset hypogonadism (LOH) is preferred. The diagnosis of LOH is often uncertain because symptoms (occurring in 20-40% of men) and low circulating testosterone (found in 20% of men >70 years of age) seldom occur together. The strict diagnostic criteria for LOH include reproducibly low serum testosterone levels and sexual symptoms, including erectile dysfunction and reduced frequency of sexual thoughts and morning erections. Using these diagnostic criteria, only 2% of 40-80-year-old men have LOH. Obesity and impaired general health (including diabetes mellitus, cardiovascular and chronic obstructive pulmonary disease, and frailty) are more common reasons for low testosterone than advanced age per se. It seems logical, therefore, to begin by treating these conditions before testosterone replacement therapy is initiated. Even then, testosterone should only be used if there are no contraindications, such as unstable cardiac disease, serious prostate symptoms and high hemoglobin level. The long-term benefit of testosterone replacement therapy is uncertain, and the experimental nature of the treatment, and its associated risks, must be fully explained to the patient before treatment begins.

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Crossref · 10.1038/nrurol.2011.47

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61 of 61 references verified0 citation errors · 0 not checkable

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  • Serum testosterone levels decline with age, commencing in men in their mid-30s and decreasing at an average annual rate of 1.6%.

    “We speculate that this phenomenon may be attributed to the gradual decline in serum testosterone levels with age, commencing in men in their mid-30s and decreasing at an average annual rate of 1.6%38–43.”

    From Association between serum cotinine and total testosterone in adult males based on NHANES 2011–2016 (2024) · cites this paper as [43]

  • Testosterone concentrations in nonclassical hypogonadism typically range from 8-12 nmol/L.

    “Testosterone concentrations in nonclassical hypogonadism typically range from 8-12 nmol/L.40”

    From Hypogonadism and male obesity: Focus on unresolved questions (2018) · cites this paper as [40]

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Authors
Huhtaniemi, I., & Forti, G.
Affiliations
  • Imperial College London (GB)
  • University of Florence (IT)
Corresponding author
Huhtaniemi, Ilpo
ORCID
Huhtaniemi, Ilpo
Venue
Nature Reviews Urology
Publisher
Springer Science and Business Media LLC
Published
2011-04-19
Volume
8
Issue
6
Pages
335-344
ISSN
  • 1759-4812 (ISSN-L)
  • 1759-4820
DOI
10.1038/nrurol.2011.47
OpenAlex
W2113409017
Cited by
88
References
64
Citations by year
2026: 4 · 2025: 6 · 2024: 7 · 2023: 1 · 2022: 7 · 2021: 8 · 2020: 9 · 2019: 8 · 2018: 4 · 2017: 4 · 2016: 2 · 2015: 9 · 2014: 9 · 2013: 5 · 2012: 4
FWCI
0.85
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Nature Reviews Urology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
andropause, male hypogonadism, androgen deficiency, testosterone replacement therapy, pathophysiology, diagnostic criteria, erectile dysfunction, obesity, frailty, chronic obstructive pulmonary disease, diabetes mellitus, cardiovascular disease, treatment risks
MeSH terms
Aging, Animals, Humans, Hypogonadism, Erectile Dysfunction, Male, Obesity, Testosterone, Treatment Outcome, Age of Onset, Hormone Replacement Therapy

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