Korean J Urol.  2011 Nov;52(11):725-735.

Diagnosis and Treatment of Sexual Dysfunctions in Late-Onset Hypogonadism

• Kim JW
• Moon DG

Abstract

Testosterone is the principal androgen in the human male. The decline of testosterone with aging was recognized to be associated with a number of symptoms and signs that reduce the quality of life and that may even have severe, debilitating consequences. Clinically, late-onset hypogonadism (LOH) is diagnosed by use of biochemical and clinical measures. Despite published guidelines and recommendations, however, uncertainty surrounds the profile of clinical symptoms as well as the biochemical threshold of diagnosis. Clinicians should be aware of these shortcomings while adhering to the guidelines. Current treatment methods are centered on restoring testosterone to mid to lower levels of young men with natural testosterone replacements. Although recent studies have highlighted possible additional benefits involving improvement of systemic disorders, the goal of treatment is to improve sexual function, while observing for adverse effects in the prostate. Overall, the problem of LOH in debilitating the quality of life and well-being is real, and by following proper guidelines with attentiveness to the results of treatment trials, testosterone replacement therapy presents a safe and effective treatment option.

Keyword

Erectile dysfunction; Hormone replacement therapy; Hypogonadism; Libido; Testosterone

MeSH Terms

Aging
Erectile Dysfunction
Hormone Replacement Therapy
Humans
Hypogonadism
Libido
Male
Prostate
Quality of Life
Testosterone
Uncertainty
Testosterone

Figure

• 

  FIG. 1 Diagnostic algorithm for late-onset hypogonadism [95]. Recommendations by the ISSAM suggest a serum sample for total testosterone, taken between 700 and 1,100 hours, for patients who are at risk or suspected of hypogonadism. Total testosterone above 12 nmol/l does not require treatment. Patients with serum total testosterone below 8 nmol/l will usually benefit from treatment. If the total testosterone is between 8 and 12 nmol/l, the measurement of total testosterone should be repeated with sex hormone-binding globulin to calculate free testosterone. Measurements of serum LH will assist in differentiating between primary and secondary hypogonadism. LH: luteinizing hormone, FSH: follicle stimulating hormone.

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