Epidemiology

Several epidemiological studies confirm age-related decreases in serum total testosterone concentrations.[9] In one US study, the prevalence of symptomatic androgen deficiency was 5.6% in men aged between 30 and 79 years.[10] Prevalence was low (3% to 7%) in men aged under 70 years and increased markedly to 18.4% among men 70 years and older.[10]

The European Male Ageing Study (EMAS) investigated different forms of hypogonadism in aging men. Pathological primary hypogonadism was reported in 2% of men (with incidence increasing 0.2% per year); 9.5% of men had normal testosterone levels but raised LH ("compensated hypogonadism").[5] Late-onset hypogonadism (LOH; defined as decreased sexual interest, decreased morning erections, and erectile dysfunction, in combination with testosterone deficiency in older men lacking any pathological cause) was reported in 2.1% in men ages 40-79 years.[5][6]​​​​[11][12]​​​​ The age-related accumulation of nongonadal comorbidities causing gonadotropin suppression (e.g., obesity) was the principal risk factor for falling testosterone levels in men with LOH.[5][13]​​ Men with LOH were at increased risk for diabetes and cardiovascular disease compared with eugonadal men.[12] Broadly similar findings were reported in the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) study.[14]

Estimation of hypogonadism prevalence based on large population database surveys of testosterone replacement therapy prescriptions is not recommended; studies have found that testosterone therapy is often initiated in the absence of a diagnosis of hypogonadism as specified by guideline recommendations.[7]

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