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Prevalence of Symptomatic Androgen Deficiency in Men
Abstract
Context: Despite recognition that androgen deficiency in men should be defined according to biochemical and clinical criteria, most prevalence estimates are based on low testosterone levels alone. Objective: The objective of this study was to examine the association between symptoms of androgen deficiency and low total and calculated free testosterone levels and estimate the prevalence of symptomatic androgen deficiency in men. Design: This study was a population-based, observational survey. Participants: A total of 1475 Black, Hispanic, and white men, between the ages of 30–79 yr, with complete data on testosterone, SHBG, and symptoms of androgen deficiency, and who are not taking medications that impact sex steroid levels were randomly selected from the Boston Area Community Health Survey. Outcome: Outcomes were measured as symptomatic androgen deficiency, defined as low total (<300 ng/dl) and free (<5 ng/dl) testosterone plus presence of low libido, erectile dysfunction, osteoporosis or fracture, or two or more of following symptoms: sleep disturbance, depressed mood, lethargy, or diminished physical performance. Results: Mean age of the sample was 47.3 ± 12.5 yr. Approximately 24% of subjects had total testosterone less than 300 ng/dl, and 11% of subjects had free testosterone less than 5 ng/dl. Prevalence of symptoms were as follows: low libido (12%), erectile dysfunction (16%), osteoporosis/fracture (1%), and two or more of the nonspecific symptoms (20%). Low testosterone levels were associated with symptoms, but many men with low testosterone levels were asymptomatic (e.g. in men 50+ yr, 47.6%). Crude prevalence of symptomatic androgen deficiency was 5.6% (95% confidence interval: 3.6%, 8.6%), and was not significantly related to race and ethnic group. Prevalence was low in men less than 70 yr (3.1–7.0%) and increased markedly with age to 18.4% among 70 yr olds. Projection of these estimates to the year 2025 suggests that there will be as many as 6.5 million American men ages 30–79 yr with symptomatic androgen deficiency, an increase of 38% from 2000 population estimates. Conclusions: Prevalence of symptomatic androgen deficiency in men 30 and 79 yr of age is 5.6% and increases substantially with age. The aging of the U.S. male population will cause a large increase in the burden of symptomatic androgen deficiency. Future work should address the clinical significance of low testosterone levels in asymptomatic men.
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“The prevalence of symptomatic hypogonadism remains poorly defined, with estimates ranging from 2.1–17% in population-based surveys of men aged 30–87 years depending upon criterion utilized.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [2]
In the citing paper
“However, many of these studies are hindered by heterogeneity in the definition for low fT (50–65 pg/ml [173.4–225.4 pmol/L]), with increases in the threshold for low fT resulting in higher sensitivity and reduced specificity when compared to TT.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [2]
In the citing paper
“Other studies have also demonstrated increased associations between fT and other comorbid conditions, including depression and hypogonadal symptoms.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [2]
In the citing paper
“Free T is also better indicator in young males as compared to elderly men, suggesting that the age-associated increase in SHBG may further reduce the specificity of fT.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [2]
In the citing paper
“The authors noted that increasing the lower fT threshold (50–60, or 60–70pg/ml [173.4–208 and 208–242.7 pmol/L]) resulted in reduced specificity for symptoms such as low libido (28.1%, 23.9%, and 19.8% for 50, 60, and 70pg/ml [242.7 pmol/L], respectively).”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [2]
In the citing paper
“The community prevalence estimates of potentially functional hypogonadism in middle-aged and older men (also referred to as late-onset, age-related, or adult-onset hypogonadism) vary from 2.1% to 12.3% (8–10)”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [9]
In the citing paper
“In other observational studies of middle-aged and older men, symptoms and low testosterone also seldomly occurred together (Supplemental Fig. 1) (8–10).”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [9]
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Metadata
- Authors
- Araujo, A. B., Esche, G. R., Kupelian, V., O’Donnell, A. B., Travison, T. G., Williams, R. E., Clark, R. V., & McKinlay, J. B.
- Affiliations
- New England Research Institutes, Inc. (A.B.A., G.R.E., V.K., A.B.O., T.G.T., J.B.M.), Watertown, Massachusetts 02472
- New England Research Institutes (US)
- GlaxoSmithKline (United States) (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2007-11-01
- Volume
- 92
- Issue
- 11
- Pages
- 4241-4247
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2135798327
- Cited by
- 720
- References
- 45
- Citations by year
- 2026: 16 · 2025: 32 · 2024: 23 · 2023: 31 · 2022: 46 · 2021: 30 · 2020: 40 · 2019: 29 · 2018: 28 · 2017: 46 · 2016: 58 · 2015: 49 · 2014: 57 · 2013: 48 · 2012: 45
- FWCI
- 25.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R01AG020727)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK56842)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Keywords
- androgen deficiency, free testosterone, prevalence, men, low libido, erectile dysfunction, osteoporosis, sex hormone-binding globulin, age-related decline, racial and ethnic differences, sex steroid levels, sleep disorders, depressive mood, physical performance, men's health, older men
- MeSH terms
- Adult, Aged, Androgens, Boston, Data Interpretation, Statistical, Endocrine System Diseases, Ethnicity, Humans, Male, Middle Aged, Gonadal Steroid Hormones, Testosterone, Cluster Analysis
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