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Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men

Wu, Frederick C. W.; Tajar, Abdelouahid; Beynon, Jennifer M.; Pye, Stephen R.; Silman, Alan J.; Finn, Joseph D.; O'Neill, Terence W.; Bartfai, Gyorgy; Casanueva, Felipe F. and Forti, Gianni, et al. (2010) 88th Annual Meeting of the Endocrine-Society In New England Journal of Medicine 363(2). p.123-135
Abstract
BACKGROUND The association between aging-related testosterone deficiency and late-onset hypogonadism in men remains a controversial concept. We sought evidence-based criteria for identifying late-onset hypogonadism in the general population on the basis of an association between symptoms and a low testosterone level. METHODS We surveyed a random population sample of 3369 men between the ages of 40 and 79 years at eight European centers. Using questionnaires, we collected data with regard to the subjects' general, sexual, physical, and psychological health. Levels of total testosterone were measured in morning blood samples by mass spectrometry, and free testosterone levels were calculated with the use of Vermeulen's formula. Data were... (More)
BACKGROUND The association between aging-related testosterone deficiency and late-onset hypogonadism in men remains a controversial concept. We sought evidence-based criteria for identifying late-onset hypogonadism in the general population on the basis of an association between symptoms and a low testosterone level. METHODS We surveyed a random population sample of 3369 men between the ages of 40 and 79 years at eight European centers. Using questionnaires, we collected data with regard to the subjects' general, sexual, physical, and psychological health. Levels of total testosterone were measured in morning blood samples by mass spectrometry, and free testosterone levels were calculated with the use of Vermeulen's formula. Data were randomly split into separate training and validation sets for confirmatory analyses. RESULTS In the training set, symptoms of poor morning erection, low sexual desire, erectile dysfunction, inability to perform vigorous activity, depression, and fatigue were significantly related to the testosterone level. Increased probabilities of the three sexual symptoms and limited physical vigor were discernible with decreased testosterone levels (ranges, 8.0 to 13.0 nmol per liter [2.3 to 3.7 ng per milliliter] for total testosterone and 160 to 280 pmol per liter [46 to 81 pg per milliliter] for free testosterone). However, only the three sexual symptoms had a syndromic association with decreased testosterone levels. An inverse relationship between an increasing number of sexual symptoms and a decreasing testosterone level was observed. These relationships were independently confirmed in the validation set, in which the strengths of the association between symptoms and low testosterone levels determined the minimum criteria necessary to identify late-onset hypogonadism. CONCLUSIONS Late-onset hypogonadism can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter). (Less)
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published
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in
New England Journal of Medicine
volume
363
issue
2
pages
123 - 135
publisher
Massachusetts Medical Society
conference name
88th Annual Meeting of the Endocrine-Society
external identifiers
  • wos:000279574100005
  • scopus:77954414397
ISSN
1533-4406
0028-4793
DOI
10.1056/NEJMoa0911101
language
English
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yes
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32498695-403e-4adf-9d9d-ed38c049c1c8 (old id 1628772)
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2010-07-23 10:58:20
date last changed
2018-07-22 03:18:43
@inproceedings{32498695-403e-4adf-9d9d-ed38c049c1c8,
  abstract     = {BACKGROUND The association between aging-related testosterone deficiency and late-onset hypogonadism in men remains a controversial concept. We sought evidence-based criteria for identifying late-onset hypogonadism in the general population on the basis of an association between symptoms and a low testosterone level. METHODS We surveyed a random population sample of 3369 men between the ages of 40 and 79 years at eight European centers. Using questionnaires, we collected data with regard to the subjects' general, sexual, physical, and psychological health. Levels of total testosterone were measured in morning blood samples by mass spectrometry, and free testosterone levels were calculated with the use of Vermeulen's formula. Data were randomly split into separate training and validation sets for confirmatory analyses. RESULTS In the training set, symptoms of poor morning erection, low sexual desire, erectile dysfunction, inability to perform vigorous activity, depression, and fatigue were significantly related to the testosterone level. Increased probabilities of the three sexual symptoms and limited physical vigor were discernible with decreased testosterone levels (ranges, 8.0 to 13.0 nmol per liter [2.3 to 3.7 ng per milliliter] for total testosterone and 160 to 280 pmol per liter [46 to 81 pg per milliliter] for free testosterone). However, only the three sexual symptoms had a syndromic association with decreased testosterone levels. An inverse relationship between an increasing number of sexual symptoms and a decreasing testosterone level was observed. These relationships were independently confirmed in the validation set, in which the strengths of the association between symptoms and low testosterone levels determined the minimum criteria necessary to identify late-onset hypogonadism. CONCLUSIONS Late-onset hypogonadism can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter).},
  author       = {Wu, Frederick C. W. and Tajar, Abdelouahid and Beynon, Jennifer M. and Pye, Stephen R. and Silman, Alan J. and Finn, Joseph D. and O'Neill, Terence W. and Bartfai, Gyorgy and Casanueva, Felipe F. and Forti, Gianni and Giwercman, Aleksander and Han, Thang S. and Kula, Krzysztof and Lean, Michael E. J. and Pendleton, Neil and Punab, Margus and Boonen, Steven and Vanderschueren, Dirk and Labrie, Fernand and Huhtaniemi, Ilpo T.},
  booktitle    = {New England Journal of Medicine},
  issn         = {1533-4406},
  language     = {eng},
  number       = {2},
  pages        = {123--135},
  publisher    = {Massachusetts Medical Society},
  title        = {Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men},
  url          = {http://dx.doi.org/10.1056/NEJMoa0911101},
  volume       = {363},
  year         = {2010},
}