The laboratory assessment of partial androgen deficiency of the aging male

The diagnosis of andropause, currently named partial androgen deficiency of the aging male (PADAM), by the International Society for the Study of Aging Male (ISSAM), is based on the presence of clinical symptoms together with a biochemical evidence of hypogonadism. Thus, the definition of specific diagnostic criteria, both as clinical manifestations and laboratory findings, is fundamental to identify those men for whom androgen replacement therapy should be warranted. Clinical manifestations suspected to be caused by androgen deficiency are numerous (decreased libido and erectile dysfunction, decreased muscle mass and strength, decreased bone mineral density, increased fat mass, depression, fatigue, irritability, etc) and, for these, the linkage to a real hypogonadal state must be confirmed on an individual basis. In this regard, the exact list of reproductive hormones to be evaluated, for screening or for diagnosis confirmation, together with eventual dynamic endocrine test (GnRH, hCG, clomiphene, etc) must be adjusted. Furthermore, the clinician must be aware of the methods and limits of androgen assays in order to be able to specifically select, where possible, those which are validated by comparison to a "gold standard" or accepted method of measurement.