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New Research on Adult-Onset Hypogonadism Provides “Conceptual Framework” for Healthcare Providers

A new literature review published today in Mayo Clinic Proceedings provides some insight into adult-onset hypogonadism (AOH), a condition in which middle-aged and older men have low levels of testosterone.

The research project is the result of a colloquium held in Washington DC last summer by the Sexual Medicine Society of North America (SMSNA). At that meeting, seventeen experts in the fields of men’s health, sexual medicine, urology, endocrinology, and methodology discussed the diagnosis and management of AOH as well as the reasons a physician might consider testosterone therapy for men with AOH.

The goal of the resulting study was to “support health care professionals in the development of a deeper understanding of AOH, particularly in how it differs from classical primary and secondary hypogonadism, and to provide a conceptual framework to guide its diagnosis, treatment, and follow-up.”

Primary hypogonadism occurs when a man’s testes do not function properly and, therefore, cannot produce adequate amounts of testosterone. Secondary hypogonadism is caused by problems in areas of the brain responsible for testosterone production.

A man’s testosterone levels naturally decline as he ages. But declines in testosterone are also associated with other conditions that are common in older men, like metabolic syndrome, diabetes, hypertension, and obesity.

Testosterone levels can also be affected by certain drugs, like anabolic steroids, opioids, tricyclic antidepressants, nicotine, and marijuana.

Men with low testosterone often experience sexual dysfunction, including low libido, erectile dysfunction, or delayed ejaculation. They may also feel fatigued, weak, and depressed.

Treatment of low testosterone sometimes includes lifestyle changes (like losing weight) and managing the comorbidities that could be contributing factors (such as keeping blood sugar under control).

Testosterone replacement therapy is currently approved by the U.S. Food and Drug Administration (FDA) for primary and secondary hypogonadism, but not adult-onset hypogonadism. In 2015, the FDA called for labeling changes on FDA-approved testosterone products as well as further research, as concerns had been raised about the therapy and cardiovascular risk.

In the study, the authors discuss research on the safety of testosterone therapy, noting that low testosterone is associated with an increased risk for heart disease.

They added that testosterone treatment does not increase a man’s risk for prostate cancer. Also, there is no evidence showing that testosterone therapy worsens an enlarged prostate or related urinary symptoms.

“Clinical evidence supports the authenticity of [adult-onset hypogonadism] and its health relevance,” the authors wrote in their conclusion.

“Importantly, improved clinical management can be expected to result from ongoing rigorous investigation of diagnostic criteria and demonstration of efficacy and safety of treatments for this syndrome,” they said.

Patients concerned about low testosterone are encouraged to see their healthcare provider for a complete check-up.


Mayo Clinic Proceedings

Khera, Mohit, MD, MBA, MPH, et al. “Adult-Onset Hypogonadism”

(Full-text. June 21, 2016)