Three sexual symptoms indicate hypogonadism in older men

A new study has identified three sexual symptoms that, when combined with measurement of testosterone levels, can be used to diagnose late-onset hypogonadism.

Researchers randomly surveyed more than 3,000 European men between the ages of 40 and 79. They measured the men's total and free testosterone, and asked them about their general, sexual, physical and psychological health. The study found nine symptoms that were associated with lower testosterone levels: three sexual symptoms (decreased frequency of morning erection, decreased frequency of sexual thoughts and erectile dysfunction), three physical symptoms (an inability to engage in vigorous activity, an inability to walk more than 1 km and an inability to bend, kneel or stoop), and three psychological symptoms (loss of energy, sadness and fatigue).

Although the symptoms were all associated with low testosterone, they were also common among men with normal levels, and only the three sexual symptoms had a syndromic association with decreased testosterone levels. Having more sexual symptoms was associated with lower testosterone. Overall, 2.1% of the study population had at least the three sexual symptoms as well as total testosterone less than 11 nmol/L and free testosterone less than 220 pmol/L.

Based on the results, the study authors recommend that the three sexual symptoms, along with testosterone measurement, be used as the diagnostic criteria for late-onset hypogonadism. Total testosterone should be used as the primary measurement, with the addition of free testosterone in borderline cases, they noted. Physicians should also remember that, given the overlap of conditions in aging patients, there could be alternate causes of the patients' symptoms and a comprehensive general assessment should be done.

The study is not intended to set criteria for initiating testosterone treatment, the authors wrote. They suggested that further clinical trials are required to resolve that issue, but noted that their findings could reduce excessive diagnoses of hypogonadism and curb injudicious use of testosterone therapy. The study was published in the June 16 New England Journal of Medicine.