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Predicting low testosterone in aging men: a systematic review.

Adam C Millar1, Adrian N C Lau1, George Tomlinson1

  • 1Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont.

CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
|June 22, 2016
PubMed
Summary
This summary is machine-generated.

Diagnosing hypogonadism in older men using symptoms like decreased libido or erectile dysfunction is unreliable due to weak correlations with testosterone levels. Thresholds for low testosterone also vary, complicating diagnosis in aging men.

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Area of Science:

  • Endocrinology
  • Geriatrics
  • Men's Health

Background:

  • Physicians often diagnose hypogonadism in older men using criteria established for younger men.
  • This approach may not accurately reflect age-related testosterone decline.

Purpose of the Study:

  • To systematically review the accuracy of clinical symptoms and signs in predicting low testosterone levels in aging men.
  • To assess the reliability of diagnostic methods for hypogonadism in the aging male population.

Main Methods:

  • A systematic review of MEDLINE and Embase databases (1966-2014) was conducted.
  • Studies comparing clinical features with serum testosterone measurements in men were included.
  • Data extraction and quality assessment were performed independently by three authors.

Main Results:

  • Forty studies out of 6053 identified articles met inclusion criteria.
  • Prevalence of low testosterone varied widely (2%-77%), as did reference testosterone thresholds.
  • Likelihood ratios for decreased libido and erectile dysfunction were modest; ANDROTEST showed the most favorable results among instruments.

Conclusions:

  • There is a weak correlation between common signs/symptoms and testosterone levels in aging men.
  • Uncertainty exists regarding appropriate testosterone thresholds for this demographic.
  • Current diagnostic methods for younger men are difficult to apply to age-related testosterone decline in older men.