Prevalence of hypogonadism in males aged at least 45 years
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
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What is Hypogonadism?
Hypogonadism is a genetic condition that affects the growth of the testicles. Symptoms include erectile dysfunction and changes in mood. It may also cause osteoporosis and muscle atrophy.
In men, hypogonadism can also result in infertility. Secondary symptoms may include a lack of facial hair and oligomenorrhea, which is the release of milk from the nipple outside of pregnancy.
There are several tests for hypogonadism. The first test is to check for the presence of high levels of LH and FSH in the blood.
Then, a physician may order imaging tests, such as an ultrasound of the ovaries or MRI or CT scan of the brain. If the symptoms persist, surgery or radiation therapy may be necessary.
Other symptoms of hypogonadism include obesity, aging, and inherited factors. As men age, the rate of testosterone production decreases.
Men with hypogonadism often do not seek medical attention. However, if diagnosed early enough, treatment is available. The most common treatment for hypogonadism is testosterone replacement therapy.
Hypogonadism occurs when one or both of the sex glands in the body are not functioning properly.
The lack of sex hormones is a serious problem because it interferes with the development of puberty and leads to infertility. Hypogonadism can also result in menstrual problems.
Symptoms
The prevalence of hypogonadism in men aged at least 45 years has been reported to be as high as 38.7%, based on United States census data from 2003.
If extrapolated to the current population of the United States, that figure translates to 13.8 million men aged at least 45 years presenting to their primary care physicians with symptoms of hypogonadism.
The most prominent symptom is lack of energy. Other common complaints include decreased libido and erectile dysfunction.
Testosterone replacement therapy may cause an erectile dysfunction or interfere with spermatogenesis.
There are two types of hypogonadism research. The first involves population-based studies, with large sample sizes and no age restrictions.
The second type is the screening-based study, which recruits healthy people from general health screening clinics.
The last type of study is called clinical condition-based, where the prevalence of hypogonadism is determined in specific clinical conditions.
This study included 80 patients who were being treated for hypogonadism. Nevertheless, the results of the study were not changed significantly even after excluding these patients.
In addition, the prevalence of hypogonadism in males aged at least 45 years was higher among men who were not receiving treatment. The study also found a strong relationship between BMI and hypogonadism.
Hypogonadism is a common condition in males. It is more prevalent among older men with type 2 diabetes.
It can impact men's health and quality of life. Lower levels of testosterone can lead to mood disturbances, changes in bone mineral density, and an overall decrease in feeling of well-being.
Hypogonadism can be diagnosed using a fasting serum T level. This biochemical test should be performed within 3 hours of waking.
While there is no consensus on the precise biochemical level required to diagnose hypogonadism, the American Urological Association has established a diagnostic level of 250 to 300 ng/dl.
Hypogonadism in males is caused by a dysfunction of the pituitary gland and hypothalamus. Low levels of T can result in reduced sperm production. It is usually treated by hormone therapy.
Clinical conditions
Hypogonadism is a condition in which a man lacks sufficient sperm in his ovaries. It is an infertile state that affects approximately 38.7% of men and has an impact on the quality of life.
There are several clinical conditions that can cause hypogonadism, including the following.
Primary hypogonadism results from disorders of the testes, which cause reduced testosterone and impair fertility. Secondary hypogonadism is caused by defects in the pituitary gland or hypothalamus.
Symptoms of secondary hypogonadism include low testosterone levels in laboratory tests. In rare cases, dual defects in the pituitary-hypothalamic axis can cause mixed hypogonadism, which shows an increase in LH and FSH levels.
A recent study found that nearly 40 percent of men aged 45 and older are suffering from some form of hypogonadism.
In addition, an increased BMI and increased age are associated with increased risk of hypogonadism. People with hypertension, diabetes, or asthma also have a higher risk of developing hypogonadism.
In older men, testosterone levels tend to decline. These men are considered late onset hypogonadism syndrome and have low testosterone levels, although their symptoms are more diffuse.
Hypogonadism in older men may impact sexual function, body composition, and health-related quality of life. There is also an inverse relationship between low T levels and cardiovascular morbidity.
Hypogonadism in males over 45 years may also be associated with decreased sexual function and cognitive function, as well as an elevated LDL cholesterol level.
It may also cause changes in bone density and muscle weakness. It is important to note that men with late onset hypogonadism should be tested frequently, and multiple testosterone levels should be tested.
Hypogonadism is a common condition that affects men and causes a decrease in sexual performance and desire.
Additionally, it may also result in physical exhaustion, a lack of vitality, and a diminished sense of well-being. Nearly 60 percent of hypogonad patients experience one or more of these symptoms.
Testosterone replacement therapy may increase bone density in hypogonadal men. However, it is important to note that testosterone replacement therapy is not a cure for hypogonadism.
It is not approved by the US Food and Drug Administration (FDA) for increasing strength, improving appearance, or treating aging-related problems.
There are some concerns about long-term testosterone replacement in hypogonadal men, including a potential risk of prostate cancer and cardiovascular events.
Treatment
A comprehensive biochemical workup is necessary to diagnose hypogonadism in males. Serum total testosterone (TT) and free testosterone (FT) levels are key markers of hypogonadism.
Although a decrease in serum T can be transient due to acute illnesses, repeat hormone measurement is necessary to rule out hypogonadism.
The American Association of Clinical Endocrinologists revised its guidelines for hypogonadism in males in 2002.
This new standard of care includes a complete assessment of symptoms, including urinary tract and prostate symptoms. Patients may also be prescribed hormone replacement therapy.
Primary hypogonadism is caused by an underlying disease or condition. Secondary hypogonadism results from defects of the hypothalamic-pituitary axis or a tumour. Both conditions cause low levels of testosterone and LH.
Despite the limited sensitivity of the AMS questionnaire, this tool is useful to determine the presence or absence of hypogonadism.
While testosterone levels may increase with testosterone treatment, it may not improve the patient's symptoms. Therefore, other methods may be necessary to confirm if testosterone therapy is the right treatment for the patient.
The American Association of Clinical Endocrinologists has outlined a new set of clinical guidelines for the treatment of hypogonadism in male patients aged 45 years and older.
These guidelines have shown that testosterone replacement therapy, or TRT, improves muscle strength, body composition, and cardiovascular biochemical risk factors.
Treatment of hypogonadism in mature men involves identifying the underlying cause of hypogonadism and treating it as a disease.
This disease is also associated with thyroidopathy, type 2 diabetes mellitus, and obesity.
In addition to testosterone replacement therapy, patients should be monitored for prostate disease. They should have their PSA levels measured every 3-6 months and then annually.
The PSA level will increase in men with more severe hypogonadism than in those with milder cases. Patients should compare their PSA levels before and after testosterone replacement.
TRT has also been associated with improved lipid profiles and body composition in men with TD. TRT also improves the fasting glucose levels in these men.
Under-reporting
Hypogonadism in males occurs when the serum testosterone level is lower than normal.
This condition is often characterized by a constellation of symptoms including decreased libido, erectile dysfunction, decreased ejaculate volume, and loss of body hair.
Men who experience hypogonadism may also experience anemia or fatigue. However, despite these symptoms, men with hypogonadism often do not seek medical attention.
The study included 756 men aged at least 45 years old who had a history of hypogonadism.
The authors found that the risk of hypogonadism was higher in men with hypertension, diabetes, and obesity, and in those with prostate disease. In addition, the study found a higher prevalence of hypogonadism in men with a higher BMI.
The most common symptoms of hypogonadism were fatigue, erectile dysfunction, and gynecomastia.
The most common causes of hypogonadism were age, obesity, opiate use, and pituitary adenoma. In addition, patients with a history of hypertension, diabetes, or asthma had an increased risk of developing hypogonadism.
Primary hypogonadism results from a deficiency in testosterone or androgen. It can be congenital or acquired later in life.
The symptoms may include decreased energy, decreased motivation, and decreased libido.
Studies have shown that men who receive TTH for hypogonadism are less likely to be hospitalized than those who receive eugonadism therapy.
However, the reduction in the risk of hospitalization is limited to men with adequate TTH.
Unfortunately, the reasons for inadequate TTH are not always recorded in medical records. Inadequate treatment regimens are often related to patient compliance or missed clinic visits.
Conclusion
A study of over 26,000 men aged 45 years and older has found a relatively high prevalence of hypogonadism. Almost one in every five men with this condition visits their primary care physician at some point in their life.
This condition is more common than eugonadal men and can negatively impact a man's quality of life. To estimate the prevalence, researchers analyzed data from 2650 primary care practices in the United States.
Participants had to meet certain inclusion criteria in order to be included in the study. They also had to be willing to provide a blood sample and answer questions about their medical history.
Patients were assessed for hypogonadism by comparing the levels of testosterone (T4) in the mornings (8-10 am) and afternoons (10 am - noon). Physicians also recorded demographic data on case report forms.
In addition, they interviewed patients to assess the severity of hypogonadism symptoms, which included decreased sexual desire and strength, and general feeling of weakness.
In a study conducted in men aged at least 45 years, the prevalence of hypogonadism increased with increasing age and BMI.
Patients with chronic diseases such as hypertension, diabetes, or dyslipidemia were also at a higher risk of developing hypogonadism.
