A panel of experts has developed a “conceptual framework” for the diagnosis, treatment, and management of adult-onset hypogonadism (AOH) – low testosterone levels in middle-aged and older men.
The paper, recently published in Mayo Clinic Proceedings, is a literature review designed 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.”
The review stems from a colloquium held by the Sexual Medicine Society of North America (SMSNA), a regional society affiliated with the ISSM. At that time, seventeen specialists from various backgrounds – including men’s health, sexual medicine, urology, endocrinology, and methodology – attended the meeting in Washington DC.
The authors distinguish AOH from primary hypogonadism (caused by testicular dysfunction) and secondary hypogonadism (which can be caused by problems in the pituitary gland or the hypothalamus, both located in the brain).
AOH refers to the gradual decline in testosterone levels experienced by men as they age. This decline is sometimes linked to other conditions often found in older men, like diabetes, hypertension, and obesity. Certain drugs, like anabolic steroids, opioids, and marijuana are also associated with lower testosterone levels.
As a result, men with AOH often feel fatigued, weak, and irritable. Their sexual health can suffer as well. Low libido, erectile dysfunction, and delayed ejaculation are common symptoms of AOH.
There are several approaches to treating AOH. In some cases, lifestyle modifications, such getting more exercise or maintaining a healthy weight, are warranted. Managing health conditions associated with AOH, like diabetes, may also help.
Testosterone replacement therapy is another option. However, the U.S. Food and Drug Administration (FDA) has not approved this treatment for AOH. Testosterone is FDA-approved only for the treatment of primary and secondary hypogonadism.
Last year, after concerns over cardiovascular risk were raised, the FDA began requiring testosterone manufacturers to clearly specify the approved uses of testosterone on product labels.
The panel considered such risks in their literature review. They concluded that low testosterone is linked to elevated risk for heart disease. They also found that testosterone replacement therapy does not raise the risk of prostate cancer, nor does it appear to worsen an enlarged prostate or lower urinary tract symptoms.
AOH still needs more study, the authors noted. “[I]t is important to acknowledge gaps in the understanding of this syndrome and its treatment. Ongoing research efforts should focus on epidemiology, disease risk associations, pathophysiology, molecular pharmacotherapeutics, and health-related outcomes of its diagnosis and treatment.
“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 added.
Mayo Clinic Proceedings
Khera, Mohit, MD, MBA, MPH, et al.
(Full-text. June 21, 2016)
“New Research on Adult-Onset Hypogonadism Provides “Conceptual Framework”
(June 21, 2016)