Materiały źródłowe

• #1 Epidemiology of Male Hypogonadism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9136962/

  The epidemiology of male hypogonadism has been understudied. Of the known causes of endogenous androgen deficiency, only Klinefelter syndrome is common with a likely population prevalence of 5:10,000 men (possibly as high as 1025:10,000). Mild traumatic injury might also be a common cause of androgen deficiency (prevalence 510:10,000 men), but large, long-term studies must be completed to confirm this prevalence estimation that might be too high. The classic causes of male androgen deficiencyhyperprolactinemia, pituitary macroadenoma, endogenous Cushing syndrome and iron overload syndrome are rare (prevalence 10,000 men). Of the iatrogenic causes of male androgen deficiency, androgen deprivation therapy for prostate cancer, radiation and chemotherapy for testicular cancer, lymphoma and leukemia, and radiation therapy for primary brain tumors and head and neck cancers are common (prevalence 5:10,000 men).

• #1 Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/

  Hypogonadism affects an estimated 4 to 5 million men in the United States, and although it may occur in men at any age, low testosterone levels are especially common in older males. […] Studies suggest that hypogonadism in adult men is often underdiagnosed and under treated. […] In fact, only about 5% of hypogonadal men receive testosterone replacement. […] Some experts also believe that we need to reevaluate normal testosterone levels and lower the diagnostic cutoff for hypogonadism. […] An inexpensive and reliable screening test for hypogonadism is a morning serum total testosterone level, which measures free testosterone plus protein-bound testosterone. […] Morning testosterone values 300 ng/dL (10.4 nmol/L) suggest hypogonadism and should be confirmed by a second assay. […] Once testosterone deficiency is confirmed, we then consider testosterone replacement therapy.

• #1 Hypogonadism epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hypogonadism_epidemiology_and_demographics

  The prevalence of hypogonadism in men is estimated to be 38,700 per 100,000 individual aging 45 years. The incidence of hypogonadism is 1230 per 100,000 persons. Hypogonadism affects men more than women and its prevalence increases with age. […] The prevalence of hypogonadism in men is 38,700 per 100,000 persons aged 45 years. […] The prevalence of androgen deficiency ranges from a low of 6,000 per 100,000 persons aged 40 years to a high of 12,000 per 100,000 persons aging 70 years. […] There are no sufficient prevalence results for hypogonadism in women. […] The incidence of hypogonadism is 1230 per 100,000 persons. The rate may be increasing. […] Hypogonadism is more common in the males than females. […] The prevalence of hypogonadism increases with age. […] There is no racial predilection of hypogonadism.

• #1 Recognizing the Signs and Symptoms of Male Hypogonadism, or Low T | Endo

  https://www.endo.com/newsroom/stories/recognizing-the-signs-and-symptoms-of-male-hypogonadism-or-low-t/

  It is estimated that 2% of males in the United States may have low testosterone, and about 12% of men in their 50s and up to 50% of men in their 80s may develop it. […] Only about 5% of men with Low T are being treated. […] Doctors base a diagnosis of hypogonadism on symptoms and results of blood tests that measure testosterone levels. […] Seftel AD. Male hypogonadism. Part I: epidemiology of hypogonadism. Int J Impot Res. 2006;18(2): 115120.

• #1 Epidemiology of Male Hypogonadism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9136962/

  This final limitation is very important because it precludes the accurate assessment of the global and the locoregional epidemiology of male hypogonadism. […] The prevalence of hypogonadism is much lower in older men when low serum testosterone concentrations are coupled with symptoms suggestive of hypogonadism. […] The prevalence of male androgen deficiency due to known pathological causes is low, and the prevalence of low serum testosterone concentrations is high in men over age 40. Screening for male hypogonadism in adults is not warranted. […] Overall, the prevalence of male hypogonadism due to known endogenous pathological causes is low (likely 1%). Iatrogenic causes of male hypogonadism may significantly raise the prevalence of male hypogonadism, particularly in middle-aged and older men who are more likely to be affected by these iatrogenic causes.

• #1 Review of health risks of low testosterone and testosterone administration

  https://wjgnet.com/2307-8960/full/v3/i4/338.htm

  LOW TESTOSTERONE EPIDEMIOLOGY AND RISKS Production of testosterone (T) and serum T concentrations decline as men age. Hypogonadism may be defined either as serum concentration of T (either total T, bioavailable T or free T) or as low T plus symptoms of hypogonadism. The Baltimore Longitudinal Study on Aging reported the incidence of total serum T 325 ng/dL to be 20% for men in their 60s, 30% for men in their 70s and 50% for men over 80. In an authoritative review by Kaufman and Vermeulen in 2005, similar rates and trends in the reduction of total serum T level were reported. The Massachusetts Aging Male Study reported that 12.3% of men aged 40 to 70 had a total serum T of 200 ng/dL with 3 or more symptoms of hypogonadism. The Boston Area Community Health Study reported that 5.6% of men aged 30 to 70 were hypogonadal, as defined by total serum T 300 ng/dL; or, free serum T 5 ng/dL plus 3 or more symptoms of hypogonadism.

• #1 Review of health risks of low testosterone and testosterone administration

  https://www.wjgnet.com/2307-8960/full/v3/i4/338.htm

  LOW TESTOSTERONE EPIDEMIOLOGY AND RISKS Production of testosterone (T) and serum T concentrations decline as men age. Hypogonadism may be defined either as serum concentration of T (either total T, bioavailable T or free T) or as low T plus symptoms of hypogonadism. The Baltimore Longitudinal Study on Aging reported the incidence of total serum T 325 ng/dL to be 20% for men in their 60s, 30% for men in their 70s and 50% for men over 80. In an authoritative review by Kaufman and Vermeulen in 2005, similar rates and trends in the reduction of total serum T level were reported. The Massachusetts Aging Male Study reported that 12.3% of men aged 40 to 70 had a total serum T of 200 ng/dL with 3 or more symptoms of hypogonadism. The Boston Area Community Health Study reported that 5.6% of men aged 30 to 70 were hypogonadal, as defined by total serum T 300 ng/dL; or, free serum T 5 ng/dL plus 3 or more symptoms of hypogonadism.

• #1 Epidemiology – Primary Care Notebook

  https://primarycarenotebook.com/pages/diabetes-and-endocrinology/hypogonadism-in-the-male/epidemiology?cook=no&mentor=1

  Several epidemiological studies confirm age-related decreases in serum total testosterone concentrations. […] Estimates of testosterone deficiency prevalence vary widely, with epidemiological research being complicated by differences in study populations, methodology, type of testosterone used (total, free or bioavailable), timing of tests, assay techniques, and diagnostic criteria. […] The European Male Aging Study (EMAS) evaluated 3,369 men aged 40-79 years according to biochemistry and symptoms. TD was defined as the presence of 3 or more sexual symptoms, associated with a total testosterone less than 11 nmol/L and a free testosterone less than 0.22nmol/L. […] TD prevalence was 2.1% overall, and rates increased with age, from 0.1% in men aged 40-49, to 0.6% in men aged 50-59, 3.2% in men aged 60-69 and 5.1% in men aged 70-79. […] The prevalence of primary TD was 2%, secondary TD 11.8% and compensated (subclinical) TD 9.5%.

• #1 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-hypogonadism

  Male hypogonadism is a clinical syndrome which comprises of symptoms with or without signs and biochemical evidence of testosterone deficiency. Hypogonadism is associated with decreased testicular function and production of androgens and/or impaired sperm production. […] The prevalence of LOH increases with age, with the major causes being obesity, other co-morbidities (e.g., diabetes) and overall poor health. The incidence of hypogonadism has been reported to be between 12.3 and 11.7 cases per 1,000 people per year. Aging accounts for a low percentage of hypogonadism, as there is only a small gradual decline in testosterone, up to the age of 80 years, in healthy aging men. In men aged 40-79 years, the incidence of symptomatic hypogonadism varies between 2.1 and 5.7%. […] There is a high prevalence of LOH within specific populations, including patients with obesity, type 2 diabetes (T2DM), metabolic syndrome (MetS), cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), renal disease and cancer. In particular low testosterone levels are relatively common in men with T2DM and in those with metabolic derangements. […] Klinefelter syndrome, a trisomy associated with a 47,XXY karyotype, is the most prevalent genetic cause of primary hypogonadism, with a global prevalence of 1/500-1,000 live male births. However, 50% of individuals with Klinefelter syndrome are diagnosed during their lifetime.

• #1 Diagnosis and Evaluation of Male Hypogonadism

  https://www.medscape.org/viewarticle/575491

  After an average of 9 years of follow-up, when the same men were aged 48 through 79 years, the prevalence rose to 12.3%, with age-specific prevalences being 7.1%, 11.5%, and 22.8% for men in their 50s, 60s, and 70s, respectively. […] The crude incidence rate of symptomatic androgen deficiency was 12.3% per 1000 person-years and increased with age: 5.9%, 11.2%, and 23.3% per 1000 person-years in men who were in their 40s, 50s, and 60s, respectively, at baseline. […] In a community-based population of white, black, and Hispanic men aged 30 through 79 years, symptomatic androgen deficiency was found to have a prevalence of 5.6%, and there were no differences in prevalence rates among the three ethnic groups. […] In this population, prevalence in men younger than 70 was 3.1% to 7% but increased to 18.4% in men aged 70 and older.

• #1 Male hypogonadism. Part I: Epidemiology of hypogonadism | International Journal of Impotence Research

  https://www.nature.com/articles/3901397

  Male hypogonadism is a frequent and potentially undertreated condition. A number of longitudinal epidemiologic studies, including the Baltimore Longitudinal Study of Aging, the New Mexico Aging Process Study, and the Massachusetts Male Aging Study, have demonstrated age-related increases in the likelihood of developing hypogonadism. […] Owing to the demographic trends toward increasing population age and life expectancy, together with the emerging pandemic of diabetes and recent trend toward an increasing prevalence of obesity in the United States, clinicians are likely to encounter increasing cases of hypogonadism in the near future.

• #1 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  Male hypogonadism has been described in up to 20% of men over the age of 70 years and has been reported in 4% of all men. […] Trends demonstrating higher frequency of males affected by this disorder may be related to increased life expectancy, as rates of hypogonadism increase with age. […] In addition, the growing numbers of Americans who are overweight and who develop type 2 diabetes mellitus have also been described as potential causes for the increasing prevalence. […] Recent data have suggested that up to one-third of men with a diagnosis of type 2 diabetes and a body mass index (BMI) of 30 kg/m2 have hypogonadism defined by a low serum-free testosterone level. […] It is thought that androgens are extensively cleared in adipose tissue in obese patients. […] Furthermore, aromatization of androgens rises with increased levels of adipose tissue.

• #1 Male hypogonadism in overweight and obesity

  https://www.oaepublish.com/articles/mtod.2023.05

  Obesity-related gonadal dysfunction in males has been defined recently as male obesity secondary hypogonadism (MOSH). […] The prevalence of hypogonadism in obese male patients has been estimated as approximately 32.3% to 64%. […] A recent study described that secondary hypogonadism was present in 56% of men with obesity class II (BMI 35-39.9 kg/m2) and 61% of men with obesity class III (BMI 40 kg/m2). […] An earlier study showed that obese patients have a 2.86 times higher risk of developing secondary hypogonadism than patients who are either overweight or of average weight. […] The Massachusetts Male Ageing Study (1987 to 1997) showed that obesity is a substantial risk factor predicting the development of testosterone deficiency (OR 2.67, 95%CI: 2.0-3.57), P-value 0.0001. […] This narrative review analyzes the evidence on developing obesity-related endocrinopathies and the available management options. Further research is required to estimate the cut-off of body mass index associated with a higher risk for hypogonadism.

• #1 Male Hypogonadism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532933/

  Hypogonadism is often underreported, improperly diagnosed, and overtreated. According to studies, approximately 40% of men older than 45 and 50% of men in their 80s are hypogonadal. Testosterone levels have been found to decrease by 100 ng/dL every 10 years. Hypogonadism does not appear to be affected by racial grouping or ethnic origin. […] A recent study in nonobese diabetic males found that 29% were testosterone deficient. The visceral adiposity index was the only reliable indicator of testosterone deficiency in this group of patients.

• #1 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  Third, it is believed that in obese patients there is an increase in inflammatory mediators, which may decrease hormones that stimulate production of androgens (i.e., luteinizing hormone [LH] and gonadotropin-releasing hormone [GnRH]). […] This theory is questioned, however, when low androgen levels are observed in lean men with type 2 diabetes, demonstrating that hypogonadism in patients with diabetes may be independent of adiposity.

• #1 apem :: Annals of Pediatric Endocrinology & Metabolism

  https://e-apem.org/m/journal/view.php?number=957

  Congenital hypogonadotropic hypogonadism (CHH) is characterized by complete or partial failure of pubertal development because of inadequate secretion of gonadotropic hormones. […] CHH is one of the few treatable diseases of male infertility, although men with primary testicular dysfunction have irreversibly diminished spermatogenic capacity. […] CHH is characterized by absent or incomplete sexual development and/or infertility due to GnRH deficiency. […] GnRH deficiency is more common in boys than in girls and occurs in 1 in 4,000 10,000 men. […] The biochemical profile of CHH consists of low testosterone level and inappropriately low or normal serum gonadotropin level. […] CHH is a rare and treatable disease that is associated with infertility. […] Testicular volume is a key predictor of fertility.

• #1 Review of health risks of low testosterone and testosterone administration

  https://www.wjgnet.com/2307-8960/full/v3/i4/338.htm

  Hypogonadism causes a wide range of signs and symptoms including loss of libido, erectile dysfunction, diminished cognitive function, depression, lethargy, osteoporosis, loss of muscle mass and strength. In a literature review on the burden of hypogonadism in adult men, Maggi et al demonstrated strong evidence associating hypogonadism with sexual dysfunction and cognitive impairment; and, less compelling evidence associating hypogonadism with depressive symptoms, fractures, and mortality. Several recent studies also reported the health risks associated with untreated hypogonadism, including increased all-cause mortality, coronary artery disease, and stroke. […] Hypogonadism does not appear to be identical across racial and ethnic boundaries. In a health screening project among 819 men in Taiwan, the prevalence of hypogonadism (total serum T 300 ng/dL) ranged from 16.5% for men in their 40s, 23.0% for men in their 50s, 28.9% for men in their 60s, and 37.2% for men older than 70 years of age. The prevalence of hypogonadism among men in Taiwan is higher than the prevalence reported in the Massachusetts Male Aging Study, for a similar age group.

• #1 Hypogonadism and Low Testosterone in Men: Laboratory Support of Diagnosis and Management | Clinical Focus | Quest Diagnostics Hypogonadism and Low Testosterone in Men: Laboratory Support of Diagnosis and Management Hypogonadism and Low Testosterone in Men

  https://testdirectory.questdiagnostics.com/test/test-guides/CF_Male_Hypgonadism/hypogonadism-and-low-testosterone-in-men-laboratory-support-of-diagnosis-and-management

  Male hypogonadism is a clinical syndrome resulting from decreased testosterone and/or sperm production due to abnormalities of the testis or the hypothalamic-pituitary unit. Prevalence estimates vary depending on the approach used to make the diagnosis. […] In the United States, hypogonadism is estimated to affect about 5.4% of men; however, reported estimates vary depending on the diagnostic approach taken, which should be based on clinical and biochemical features (ie, the syndromic approach) and not based on features of one or the other. The prevalence can be as high as 24% when the diagnosis is made using only the clinical approach and 29% using only the biochemical approach, contrasting with 2% to 12% using a strictly applied syndromic approach.

• #1 How to manage low testosterone level in men: a guide for primary care | British Journal of General Practice

  https://bjgp.org/content/70/696/364

  Male hypogonadism is a clinical syndrome characterised by testosterone deficiency and impaired spermatogenesis; due either to diseases of the hypothalamus or pituitary gland, or of the testes themselves. The diagnosis requires the presence of clinical features consistent with lack of testosterone plus the finding of persistent and unequivocally low serum testosterone levels. […] Over recent years, there has been a surge in testosterone prescriptions for men with sexual dysfunction or putative age-related decline in testosterone, possibly reflecting pharmaceutical promotion, or sharing of misleading information on the internet. […] Primary hypogonadism (PH) results from intrinsic testicular dysfunction, being characterised by low testosterone, raised LH and FSH, and can thus be reliably diagnosed under almost all blood-sampling conditions. PH affects 12% of older men and it is associated with increased risk of type 2 diabetes mellitus (T2DM).

• #1 Male hypogonadism and ageing: rejuvenating the guidance | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/131-spring19/society-news/male-hypogonadism-and-ageing-rejuvenating-the-guidance/

  The Society for Endocrinologys position statement on male hypogonadism and ageing has recently been updated. […] Hypogonadism is misdiagnosed, over-diagnosed and undiagnosed in equal measures. There is a worldwide explosion in testosterone prescriptions that by no means target the men with the greatest need or potential to derive clinical benefit. […] The number of men with LoH by this original definition is small, with the European Male Ageing Study (EMAS) reporting only 2.1% of men aged greater than 40 years. […] Due to physiological suppression of the reproductive axis, older men with common medical conditions (e.g. obesity, metabolic syndrome, type 2 diabetes mellitus, chronic obstructive pulmonary disease, ischaemic heart disease, HIV, inflammatory disease, cardiac, renal and liver impairment) have a higher prevalence of borderline-low serum testosterone levels with low-normal LH. […] Testosterone treatment of men with a well-founded diagnosis of hypogonadism is effective and safe, and should not be withheld on the basis of age or disability. […] Surveillance with annual PSA measurement on testosterone treatment is recommended, with referral to urology if abnormal.

• #1 Male hypogonadism, andropause : Guidelines, reviews, epidemiology

  https://www.gfmer.ch/Guidelines/Urologic_and_male_genital_diseases/Male_hypogonadism.htm

  European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males [2020] […] Current National and International Guidelines for the Management of Male Hypogonadism: Helping Clinicians to Navigate Variation in Diagnostic Criteria and Treatment Recommendations [2020] […] Expert Opinion on the Diagnosis and Management of Male Hypogonadism in India [2023] […] Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism [2022] […] Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline [2018]

• #1 Testosterone Therapy: Review of Clinical Applications | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p441.html

  Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians. […] The use of testosterone therapy is increasingly common in the United States, with an estimated 2.3 million American men receiving the therapy in 2013. More than one-half of testosterone prescriptions are written by primary care physicians. Most of these prescriptions are for middle-aged and older men with age-related declines in testosterone, despite inconclusive data on testosterone therapy’s safety and effectiveness for this indication. […] Male hypogonadism should be diagnosed only if there are signs or symptoms of hypogonadism and total serum testosterone levels are low on at least two occasions. […] The U.S. Food and Drug Administration clarified in 2015 that prescribing testosterone for low testosterone levels due to aging constitutes off-label use.

• #1 Guidelines for Gonadotoxicity Surveillance After Childhood Cancer – Hypogonadism

  https://www.medpagetoday.com/resource-centers/hypogonadism/guidelines-gonadotoxicity-surveillance-after-childhood-cancer-/1074

  Many cancer treatments employed in pubertal, adolescent, and young adult males pose a risk for gonadotoxicity which could manifest itself in testosterone deficiency, impaired spermatogenesis, or other conditions with an adverse effect on sexual and reproductive function. […] Several sets of guidelines for surveillance of the potential health risks in childhood cancer survivors have been previously published in Europe and North America. Recently, a new set of guidelines is available based on a collaboration between the International Late Effects of Childhood Cancer Guideline Harmonization Group and the PanCareSurFup Consortium. These guidelines address how risks of gonadotoxicity have been defined and provide recommendations for surveillance. […] The multidisciplinary expert panel addressed 3 major areas of gonadotoxicity: impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction.

• #1 Guidelines for Gonadotoxicity Surveillance After Childhood Cancer – Hypogonadism

  https://www.medpagetoday.com/resource-centers/hypogonadism/guidelines-gonadotoxicity-surveillance-after-childhood-cancer-/1074

  Three primary questions were addressed including: (1) Who needs surveillance? (2) What is the recommended modality and frequency of surveillance? (3) When are specialist referrals appropriate? […] For testosterone deficiency, the panel recommended that monitoring be performed at least annually prior to the onset of puberty because adverse changes in growth stage or delayed Tanner stage were identified as potential markers of testosterone inadequacy. […] Despite the absence of any published studies on the risk of treatment-related sexual dysfunction in childhood cancer survivors, the panel recommended counseling for those who have received treatments associated with hypogonadism, radiotherapy to the testes, or surgery that produces potential damage to nerves relevant to reproductive function.

• #1 Male hypogonadism. Part I: Epidemiology of – ProQuest

  https://www.proquest.com/scholarly-journals/male-hypogonadism-part-i-epidemiology/docview/218985863/se-2

  Male hypogonadism is a frequent and potentially undertreated condition. A number of longitudinal epidemiologic studies, including the Baltimore Longitudinal Study of Aging, the New Mexico Aging Process Study, and the Massachusetts Male Aging Study, have demonstrated age-related increases in the likelihood of developing hypogonadism. […] Owing to the demographic trends toward increasing population age and life expectancy, together with the emerging pandemic of diabetes and recent trend toward an increasing prevalence of obesity in the United States, clinicians are likely to encounter increasing cases of hypogonadism in the near future. […] According to US Census Bureau projections, the number of Americans ages 65 or older will rise from approximately 35 million (12.4% of all Americans) in 2000 to nearly 55 million (16.3% of total) by 2020 and nearly 87 million (20.7%) in 2050.

• #1 Review of health risks of low testosterone and testosterone administration

  https://wjgnet.com/2307-8960/full/v3/i4/338.htm

  This investigation plainly demonstrated higher economic burden and presence of co-morbidities for hypogonadism. Additionally, it highlighted a potentially serious threat to the interpretation of all observational studies in the testosterone replacement therapy (TRT) field-compliance. Over 31% of individuals in the hypogonadal did not receive TRT during the observation period. […] An increased awareness of the health risks associated with untreated hypogonadism has caused a substantial increase in TRT utilization in men. The efficacy of TRT has been demonstrated in several randomized clinical trials and has shown minor to moderate improvements in lean mass and muscle strength, increased bone mineral density (BMD), modest enhancement in sexual function, reduced adiposity and lessening of depressive symptoms. […] However, significant questions remain regarding the safety of TRT because no large-scale randomized clinical trials have directly compared the health risks of untreated hypogonadism vs long-term TRT use.

• #2 Male Hypogonadism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532933/

  Hypogonadism is often underreported, improperly diagnosed, and overtreated. According to studies, approximately 40% of men older than 45 and 50% of men in their 80s are hypogonadal. Testosterone levels have been found to decrease by 100 ng/dL every 10 years. Hypogonadism does not appear to be affected by racial grouping or ethnic origin. […] A recent study in nonobese diabetic males found that 29% were testosterone deficient. The visceral adiposity index was the only reliable indicator of testosterone deficiency in this group of patients.

• #2 Hypogonadism and Low Testosterone in Men: Laboratory Support of Diagnosis and Management | Clinical Focus | Quest Diagnostics Hypogonadism and Low Testosterone in Men: Laboratory Support of Diagnosis and Management Hypogonadism and Low Testosterone in Men

  https://testdirectory.questdiagnostics.com/test/test-guides/CF_Male_Hypgonadism/hypogonadism-and-low-testosterone-in-men-laboratory-support-of-diagnosis-and-management

  Male hypogonadism is a clinical syndrome resulting from decreased testosterone and/or sperm production due to abnormalities of the testis or the hypothalamic-pituitary unit. Prevalence estimates vary depending on the approach used to make the diagnosis. […] In the United States, hypogonadism is estimated to affect about 5.4% of men; however, reported estimates vary depending on the diagnostic approach taken, which should be based on clinical and biochemical features (ie, the syndromic approach) and not based on features of one or the other. The prevalence can be as high as 24% when the diagnosis is made using only the clinical approach and 29% using only the biochemical approach, contrasting with 2% to 12% using a strictly applied syndromic approach.

• #2 Epidemiology – Primary Care Notebook

  https://primarycarenotebook.com/pages/diabetes-and-endocrinology/hypogonadism-in-the-male/epidemiology?cook=no&mentor=1

  Several epidemiological studies confirm age-related decreases in serum total testosterone concentrations. […] Estimates of testosterone deficiency prevalence vary widely, with epidemiological research being complicated by differences in study populations, methodology, type of testosterone used (total, free or bioavailable), timing of tests, assay techniques, and diagnostic criteria. […] The European Male Aging Study (EMAS) evaluated 3,369 men aged 40-79 years according to biochemistry and symptoms. TD was defined as the presence of 3 or more sexual symptoms, associated with a total testosterone less than 11 nmol/L and a free testosterone less than 0.22nmol/L. […] TD prevalence was 2.1% overall, and rates increased with age, from 0.1% in men aged 40-49, to 0.6% in men aged 50-59, 3.2% in men aged 60-69 and 5.1% in men aged 70-79. […] The prevalence of primary TD was 2%, secondary TD 11.8% and compensated (subclinical) TD 9.5%.

• #2 Male hypogonadism. Part I: Epidemiology of – ProQuest

  https://www.proquest.com/scholarly-journals/male-hypogonadism-part-i-epidemiology/docview/218985863/se-2

  In healthy, young eugonadal men, serum T levels range from 300 to 1050 ng/dl, but decline with advancing age, particularly after 50 years. […] Using a serum T level o325 ng/dl, the Baltimore Longitudinal Study of Aging (BLSA) reported that approximately 12, 20, 30, and 50% of men in their 50s, 60s, 70s, and 80s, respectively, are hypogonadal.

• #2 Diagnosis and Evaluation of Male Hypogonadism

  https://www.medscape.org/viewarticle/575491

  After an average of 9 years of follow-up, when the same men were aged 48 through 79 years, the prevalence rose to 12.3%, with age-specific prevalences being 7.1%, 11.5%, and 22.8% for men in their 50s, 60s, and 70s, respectively. […] The crude incidence rate of symptomatic androgen deficiency was 12.3% per 1000 person-years and increased with age: 5.9%, 11.2%, and 23.3% per 1000 person-years in men who were in their 40s, 50s, and 60s, respectively, at baseline. […] In a community-based population of white, black, and Hispanic men aged 30 through 79 years, symptomatic androgen deficiency was found to have a prevalence of 5.6%, and there were no differences in prevalence rates among the three ethnic groups. […] In this population, prevalence in men younger than 70 was 3.1% to 7% but increased to 18.4% in men aged 70 and older.

• #2 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-hypogonadism

  Male hypogonadism is a clinical syndrome which comprises of symptoms with or without signs and biochemical evidence of testosterone deficiency. Hypogonadism is associated with decreased testicular function and production of androgens and/or impaired sperm production. […] The prevalence of LOH increases with age, with the major causes being obesity, other co-morbidities (e.g., diabetes) and overall poor health. The incidence of hypogonadism has been reported to be between 12.3 and 11.7 cases per 1,000 people per year. Aging accounts for a low percentage of hypogonadism, as there is only a small gradual decline in testosterone, up to the age of 80 years, in healthy aging men. In men aged 40-79 years, the incidence of symptomatic hypogonadism varies between 2.1 and 5.7%. […] There is a high prevalence of LOH within specific populations, including patients with obesity, type 2 diabetes (T2DM), metabolic syndrome (MetS), cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), renal disease and cancer. In particular low testosterone levels are relatively common in men with T2DM and in those with metabolic derangements. […] Klinefelter syndrome, a trisomy associated with a 47,XXY karyotype, is the most prevalent genetic cause of primary hypogonadism, with a global prevalence of 1/500-1,000 live male births. However, 50% of individuals with Klinefelter syndrome are diagnosed during their lifetime.

• #2 Male hypogonadism in overweight and obesity

  https://www.oaepublish.com/articles/mtod.2023.05

  Obesity-related gonadal dysfunction in males has been defined recently as male obesity secondary hypogonadism (MOSH). […] The prevalence of hypogonadism in obese male patients has been estimated as approximately 32.3% to 64%. […] A recent study described that secondary hypogonadism was present in 56% of men with obesity class II (BMI 35-39.9 kg/m2) and 61% of men with obesity class III (BMI 40 kg/m2). […] An earlier study showed that obese patients have a 2.86 times higher risk of developing secondary hypogonadism than patients who are either overweight or of average weight. […] The Massachusetts Male Ageing Study (1987 to 1997) showed that obesity is a substantial risk factor predicting the development of testosterone deficiency (OR 2.67, 95%CI: 2.0-3.57), P-value 0.0001. […] This narrative review analyzes the evidence on developing obesity-related endocrinopathies and the available management options. Further research is required to estimate the cut-off of body mass index associated with a higher risk for hypogonadism.

• #2 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  Third, it is believed that in obese patients there is an increase in inflammatory mediators, which may decrease hormones that stimulate production of androgens (i.e., luteinizing hormone [LH] and gonadotropin-releasing hormone [GnRH]). […] This theory is questioned, however, when low androgen levels are observed in lean men with type 2 diabetes, demonstrating that hypogonadism in patients with diabetes may be independent of adiposity.

• #2 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  Male hypogonadism has been described in up to 20% of men over the age of 70 years and has been reported in 4% of all men. […] Trends demonstrating higher frequency of males affected by this disorder may be related to increased life expectancy, as rates of hypogonadism increase with age. […] In addition, the growing numbers of Americans who are overweight and who develop type 2 diabetes mellitus have also been described as potential causes for the increasing prevalence. […] Recent data have suggested that up to one-third of men with a diagnosis of type 2 diabetes and a body mass index (BMI) of 30 kg/m2 have hypogonadism defined by a low serum-free testosterone level. […] It is thought that androgens are extensively cleared in adipose tissue in obese patients. […] Furthermore, aromatization of androgens rises with increased levels of adipose tissue.

• #2 Male hypogonadism and ageing: rejuvenating the guidance | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/131-spring19/society-news/male-hypogonadism-and-ageing-rejuvenating-the-guidance/

  The Society for Endocrinologys position statement on male hypogonadism and ageing has recently been updated. […] Hypogonadism is misdiagnosed, over-diagnosed and undiagnosed in equal measures. There is a worldwide explosion in testosterone prescriptions that by no means target the men with the greatest need or potential to derive clinical benefit. […] The number of men with LoH by this original definition is small, with the European Male Ageing Study (EMAS) reporting only 2.1% of men aged greater than 40 years. […] Due to physiological suppression of the reproductive axis, older men with common medical conditions (e.g. obesity, metabolic syndrome, type 2 diabetes mellitus, chronic obstructive pulmonary disease, ischaemic heart disease, HIV, inflammatory disease, cardiac, renal and liver impairment) have a higher prevalence of borderline-low serum testosterone levels with low-normal LH. […] Testosterone treatment of men with a well-founded diagnosis of hypogonadism is effective and safe, and should not be withheld on the basis of age or disability. […] Surveillance with annual PSA measurement on testosterone treatment is recommended, with referral to urology if abnormal.

• #2 Klinefelter syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Klinefelter_syndrome

  This syndrome, evenly distributed in all ethnic groups, has a prevalence of approximately four subjects per every 10,000 (0.04%) males in the general population. However, it is estimated that only 25% of the individuals with Klinefelter syndrome are diagnosed throughout their lives. The rate of Klinefelter syndrome among infertile males is 3.1%. The syndrome is the main cause of male hypogonadism. One survey in the United Kingdom found that the majority of people with KS identify as male, however, a significant number have a different gender identity. The prevalence of KS is higher than expected in transgender women.

• #2 Hypogonadism epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hypogonadism_epidemiology_and_demographics

  The prevalence of hypogonadism in men is estimated to be 38,700 per 100,000 individual aging 45 years. The incidence of hypogonadism is 1230 per 100,000 persons. Hypogonadism affects men more than women and its prevalence increases with age. […] The prevalence of hypogonadism in men is 38,700 per 100,000 persons aged 45 years. […] The prevalence of androgen deficiency ranges from a low of 6,000 per 100,000 persons aged 40 years to a high of 12,000 per 100,000 persons aging 70 years. […] There are no sufficient prevalence results for hypogonadism in women. […] The incidence of hypogonadism is 1230 per 100,000 persons. The rate may be increasing. […] Hypogonadism is more common in the males than females. […] The prevalence of hypogonadism increases with age. […] There is no racial predilection of hypogonadism.

• #2 Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/

  Hypogonadism affects an estimated 4 to 5 million men in the United States, and although it may occur in men at any age, low testosterone levels are especially common in older males. […] Studies suggest that hypogonadism in adult men is often underdiagnosed and under treated. […] In fact, only about 5% of hypogonadal men receive testosterone replacement. […] Some experts also believe that we need to reevaluate normal testosterone levels and lower the diagnostic cutoff for hypogonadism. […] An inexpensive and reliable screening test for hypogonadism is a morning serum total testosterone level, which measures free testosterone plus protein-bound testosterone. […] Morning testosterone values 300 ng/dL (10.4 nmol/L) suggest hypogonadism and should be confirmed by a second assay. […] Once testosterone deficiency is confirmed, we then consider testosterone replacement therapy.

• #2 Recognizing the Signs and Symptoms of Male Hypogonadism, or Low T | Endo

  https://www.endo.com/newsroom/stories/recognizing-the-signs-and-symptoms-of-male-hypogonadism-or-low-t/

  It is estimated that 2% of males in the United States may have low testosterone, and about 12% of men in their 50s and up to 50% of men in their 80s may develop it. […] Only about 5% of men with Low T are being treated. […] Doctors base a diagnosis of hypogonadism on symptoms and results of blood tests that measure testosterone levels. […] Seftel AD. Male hypogonadism. Part I: epidemiology of hypogonadism. Int J Impot Res. 2006;18(2): 115120.

• #2 Guidelines for Gonadotoxicity Surveillance After Childhood Cancer – Hypogonadism

  https://www.medpagetoday.com/resource-centers/hypogonadism/guidelines-gonadotoxicity-surveillance-after-childhood-cancer-/1074

  Many cancer treatments employed in pubertal, adolescent, and young adult males pose a risk for gonadotoxicity which could manifest itself in testosterone deficiency, impaired spermatogenesis, or other conditions with an adverse effect on sexual and reproductive function. […] Several sets of guidelines for surveillance of the potential health risks in childhood cancer survivors have been previously published in Europe and North America. Recently, a new set of guidelines is available based on a collaboration between the International Late Effects of Childhood Cancer Guideline Harmonization Group and the PanCareSurFup Consortium. These guidelines address how risks of gonadotoxicity have been defined and provide recommendations for surveillance. […] The multidisciplinary expert panel addressed 3 major areas of gonadotoxicity: impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction.

• #2 Diagnostic, traitement et surveillance de l’hypogonadisme de survenue tardive chez l’homme: Recommandations officielles de l’International Society for the Study of the Aging Male (ISSAM) et commentaires | Basic and Clinical Andrology | Full Text

  https://bacandrology.biomedcentral.com/articles/10.1007/BF03035201

  Les altrations hormonales de lhomme vieillissant reprsentent un sujet dintrt croissant, aux enjeux importants lis au dveloppement attendu de cette population dhommes gs de plus de 50 ans. […] Cest pourquoi lInternational Society for the Study of the Aging Male (ISSAM) a jug opportun de faire le point sous la forme dune srie de recommandations pratiques et officielles concernant le diagnostic, le traitement et la surveillance de lhypogonadisme de survenue tardive chez lhomme. […] The International Society for the Study of the Aging Male (ISSAM) therefore felt it was a good time to review the current situation by publishing a series of practical and official guidelines concerning the diagnosis, treatment and monitoring of late-onset hypogonadism in males.

• #2 How to manage low testosterone level in men: a guide for primary care | British Journal of General Practice

  https://bjgp.org/content/70/696/364

  Secondary (or central) hypogonadism (SH) is characterised by low testosterone with low-to-normal LH and FSH levels. SH is caused by impaired hypothalamo-pituitary function and, hence, serum ferritin and pituitary hormone profile plus imaging is warranted. […] In men with verified hypogonadism, testosterone therapy maintains secondary sexual characteristics, improves psychological and sexual function, bone and muscle health, and reduces anaemia and frailty. […] International guidelines recommend measuring PSA at baseline and 36 months after starting testosterone initiation in men aged 40 years, with annual surveillance thereafter. […] Primary care physicians can confidently diagnose PH, but SH can be tricky for generalists to disentangle from NGI; nevertheless, primary care physicians have important roles in this area. […] Men are increasingly seeking testosterone measurement for a variety of reasons and GPs are thus faced with a burgeoning number of low testosterone results needing to be actioned.

• #2 Guidelines for Gonadotoxicity Surveillance After Childhood Cancer – Hypogonadism

  https://www.medpagetoday.com/resource-centers/hypogonadism/guidelines-gonadotoxicity-surveillance-after-childhood-cancer-/1074

  Three primary questions were addressed including: (1) Who needs surveillance? (2) What is the recommended modality and frequency of surveillance? (3) When are specialist referrals appropriate? […] For testosterone deficiency, the panel recommended that monitoring be performed at least annually prior to the onset of puberty because adverse changes in growth stage or delayed Tanner stage were identified as potential markers of testosterone inadequacy. […] Despite the absence of any published studies on the risk of treatment-related sexual dysfunction in childhood cancer survivors, the panel recommended counseling for those who have received treatments associated with hypogonadism, radiotherapy to the testes, or surgery that produces potential damage to nerves relevant to reproductive function.

• #2 Guidelines for Gonadotoxicity Surveillance After Childhood Cancer – Hypogonadism

  https://www.medpagetoday.com/resource-centers/hypogonadism/guidelines-gonadotoxicity-surveillance-after-childhood-cancer-/1074

  The authors emphasized the substantial knowledge gaps that limited the number of recommendations that could be made on the basis of high-quality evidence. […] Leontien Kremer, MD, PhD, from Emma Children’s Hospital, Amsterdam, the Netherlands, first author of previously published guidelines, suggested that this recent effort to consolidate information is important, but she expressed concern about the “paucity of high-quality evidence” that is available for drawing conclusions.

• #2 Male hypogonadism. Part I: Epidemiology of – ProQuest

  https://www.proquest.com/scholarly-journals/male-hypogonadism-part-i-epidemiology/docview/218985863/se-2

  Male hypogonadism is a frequent and potentially undertreated condition. A number of longitudinal epidemiologic studies, including the Baltimore Longitudinal Study of Aging, the New Mexico Aging Process Study, and the Massachusetts Male Aging Study, have demonstrated age-related increases in the likelihood of developing hypogonadism. […] Owing to the demographic trends toward increasing population age and life expectancy, together with the emerging pandemic of diabetes and recent trend toward an increasing prevalence of obesity in the United States, clinicians are likely to encounter increasing cases of hypogonadism in the near future. […] According to US Census Bureau projections, the number of Americans ages 65 or older will rise from approximately 35 million (12.4% of all Americans) in 2000 to nearly 55 million (16.3% of total) by 2020 and nearly 87 million (20.7%) in 2050.

• #2 Review of health risks of low testosterone and testosterone administration

  https://wjgnet.com/2307-8960/full/v3/i4/338.htm

  Hypogonadism causes a wide range of signs and symptoms including loss of libido, erectile dysfunction, diminished cognitive function, depression, lethargy, osteoporosis, loss of muscle mass and strength. In a literature review on the burden of hypogonadism in adult men, Maggi et al demonstrated strong evidence associating hypogonadism with sexual dysfunction and cognitive impairment; and, less compelling evidence associating hypogonadism with depressive symptoms, fractures, and mortality. Several recent studies also reported the health risks associated with untreated hypogonadism, including increased all-cause mortality, coronary artery disease, and stroke. […] In summary, the reported prevalence of low T in older men range from 5.6% to 50%, depending upon study design, level of T blood concentration used, and study subjects age. Combining serum T measurement with signs and symptoms most commonly seen with androgen deficiency are recommended in order to confirm the diagnosis of hypogonadism.

• #3 Hypogonadism: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/922038-overview

  Epidemiology […] No racial predilection has been described. […] Hypergonadotropic hypogonadism is more common in males than in females because the incidence of Klinefelter syndrome (the most common cause of primary hypogonadism in males) is higher than the incidence of Turner syndrome (the most common cause of hypogonadism in females). Incidence of hypogonadotropic hypogonadism is equal in males and females. […] Hypogonadism may occur at any age; however, consequences differ according to the age at onset. If hypogonadism occurs prenatally (even if incomplete), sexual ambiguity may result. If hypogonadism occurs before puberty, puberty does not progress. If hypogonadism occurs after puberty, infertility and sexual dysfunction result.

• #3 Klinefelter syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Klinefelter_syndrome

  This syndrome, evenly distributed in all ethnic groups, has a prevalence of approximately four subjects per every 10,000 (0.04%) males in the general population. However, it is estimated that only 25% of the individuals with Klinefelter syndrome are diagnosed throughout their lives. The rate of Klinefelter syndrome among infertile males is 3.1%. The syndrome is the main cause of male hypogonadism. One survey in the United Kingdom found that the majority of people with KS identify as male, however, a significant number have a different gender identity. The prevalence of KS is higher than expected in transgender women.

Zobacz więcej