Late-onset hypogonadism (LOH) diagnosis and treatment is complicated by poor correlation between testosterone decline and symptom severity, ethnicity-related differences in androgen receptor sensitivity, and varying normal testosterone ranges worldwide, requiring individualized treatment approaches.
Key Findings
Background
The decline in serum testosterone concentration does not correlate with the severity of LOH-related symptoms.
Aging men with LOH experience physiologic, psychiatric, and sexual symptoms related to testosterone decline with age.
The paper explicitly states 'the extent of the decline in testosterone concentration does not correlate with the severity of LOH-related symptoms.'
This poor correlation makes diagnosis and treatment of LOH difficult.
Background
Androgen receptor sensitivity, determined by glutamine repeat number, varies by ethnicity and influences the effects of testosterone.
The effects of testosterone are determined not only by serum testosterone concentration but also by androgen receptor sensitivity.
A low number of glutamine repeats is indicative of high androgenic activity.
The number of glutamine repeats shows ethnicity-related differences: fewer in African American than in Caucasian people, and more in East Asian people.
This ethnicity-related variation in androgen receptor sensitivity has clinical implications for LOH diagnosis and treatment across different populations.
Background
The Aging Males' Symptoms (AMS) scale is widely used to evaluate LOH-related symptoms.
Diagnosis of LOH is typically made using subjective symptoms combined with serum testosterone concentration.
The AMS scale is identified as a widely used tool for symptom evaluation in LOH.
Symptoms of LOH span physiologic, psychiatric, and sexual domains.
Background
The normal range of total testosterone concentration varies around the world, and clinicians should follow regional academic society guidelines.
The paper states 'the normal range of total testosterone concentration varies around the world.'
Symptoms, response to testosterone replacement therapy (TRT), and medical insurance coverage differ among ethnicities and countries.
Clinicians are advised to follow the guidelines of their regional academic society for reference ranges.
Background
Testosterone replacement therapy (TRT) is the principal treatment for LOH, with multiple types available and other treatment strategies also accessible.
TRT is described as 'the principal treatment for LOH.'
Many types of TRT exist, and other treatment strategies are also available.
Physicians are advised to treat LOH according to each patient's situation.
Related disorders to consider during treatment include diabetes, osteoporosis, metabolic syndrome, and depression.
Amano T. (2025). Late-onset hypogonadism: current methods of clinical diagnosis and treatment in Japan.. Asian journal of andrology. https://doi.org/10.4103/aja2024111