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Diagnosis, prevalence and management of Late Onset Hypogonadism (LOH)

Diagnosis, prevalence and management of Late Onset Hypogonadism (LOH)

The change of endocrine profiles over lifespan and the decline of peripheral testosterone affecting a significant percentage of the ageing male population is a recognized reality. Age-related androgen deficiency in men, also termed late-onset hypogonadism (LOH), has been found to be associated with a variety of pathological conditions in the elderly population. However, the condition is largely underdiagnosed and undertreated. LOH is a clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and a deficiency in serum testosterone levels. 

It may significantly reduce the quality of life and adversely affect the function of multiple organ systems. It may pose important risk factors for frailty, changes in body composition, cardiovascular disease, sexual dysfunction and osteoporosis. It is increasingly realized that androgens and their metabolites (Estrogens and DHT) have a large number of non-reproductive effects; they are important anabolic factors in the maintenance of muscle mass and bone mass and in both sexual and non-sexual psychological functioning. Testosterone supplementation has the potential to counteract the signs, symptoms and health risks of LOH thereby promoting successful male ageing. Indiscriminate administration of testosterone poses a risk and has to be deprecated. Its rational use by well-informed physicians, conversely, entails the chance to maintain and improve the health status of elderly men. However it is strongly advised to start testosterone therapy only when both, biochemical evidence of testosterone deficiency and the clinical picture, indicate the presence of LOH and risk factors for such therapy have been eliminated.

The physician must emphasize to the patient the need for periodic evaluations and the patients must agree to comply with these requirements. The physician’s evaluation should include an assessment of the clinical response and monitoring, and certainly requires tailoring dosage and preparation to the indications and the individual needs of the patient.

Areas of Interest / Categories: Ageing and Geriatric Health, Androgen Therapy, WAS 2007

WAS 2007

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