Late-onset hypogonadism : Review of the problem

Abstract

The study investigates late-onset hypogonadism (LOH), its influence on male joint system, build, cardiovascular system, haematopoesis, cognitive functions, and sexual function. LOH is a clinical and biochemical syndrome, which is related to aging and characterised by typical symptoms and a decreased serum testosterone level. It causes a worsened life quality, and the functions of various organs are badly affected. LOH is diagnosed when the testosterone level is below 8 nmol/l (230 ng/dl) or it is at the border-line (from 8 and 12 nmol/l) and there are LOH clinical symptoms such as a decreased libido, erectile dysfunction, reduced muscular mass and strength, increased obesity, reduced bone mineral density, osteoporosis, and depression. All patients with LOH are indicated testosterone replacement therapy (TRT). TRT is contra-indicated to patients suffering from prostate or thoracic gland carcinoma. In case of erythrocytosis (haematocrit > 52%), severe heart failure, marked prostate benign hyperplasia with the obstruction of urine pathways, and obstructive sleep apnoe syndrome, TRT is relatively contra-indicated and should not be started unless these dysfunctions are cured. The treatment of LOH requires thorough patient monitoring, which includes digital rectal examination and Prostate Specific Antigen conducted after 3-6 months and 12 months in the first treatment year. It is necessary to determine the total blood count after 3-4 and 12 months in the first treatment year and afterwards once a year.