Male late onset hypogonadism (LOH)
The International Society for the Study of the Aging Male (ISSAM) defines LOH as a clinical and biochemical syndrome associated with advancing age and characterized by typical
symptoms and a deficiency in serum testosterone levels. It may result in significant decline in the quality of life and adversely affect the function of multiple organ systems.
Previously also known as Andropause or PADAM (partial androgen deficiency in aging male) or ADAM (androgen decline in aging male) or male climateric.
Is LOH common ?
It is estimated that the male total testosterone level falls by approximately 1% per year after the age of 50. Hence, 30% of men aged 60-70 years, 70% of men aged 70-80 and 80% of men aged above 80 years have low testosterone hormone.
How do I know if I have LOH ?
Symptoms of LOH are:
(1)Diminished sexual desire (libido) and erectile quality and frequency, particularly night-time erections
(2)Changes in mood with concomitant decreases in intellectual activity, cognitive functions, memory, spatial orientation ability, fatigue, depressed mood and irritability
(4)Decrease in lean body mass with associated diminution in muscle volume and strength
(5)Increase in body fat
(6)Decrease in body hair and skin changes (e.g. dryness)
(7)Decreased bone mineral density resulting in osteoporosis and increased risk of bone fractures.
The above symptoms coupled with a blood test showing a low level of testosterone would lead to a diagnosis of LOH.
Do I need treatment for LOH ?
Clinical picture (symptoms) together with biochemical evidence of low serum testosterone (blood test) should exist prior to the initiation of LOH therapy.
How is LOH treated ?
The usual treatment is androgen (testosterone) replacement therapy (ART). Testosterone can be administered by several methods, such as injections, depots, oral, patches and gels. Each method has its strengths and weaknesses and ideally should be determined after a discussion between the patient and urologist.
ART would usually improve the above mentioned symptoms and also result in increase in serum testosterone levels. It must be monitored closely for potential side-effects which can be harmful if not detected early.
Late onset hypogonadism
Men's Health Services
S H HO UROLOGY AND LAPAROSCOPY CENTRE
Updated 8 Aug 08