Androgen deficiency: a common problem among older men
Declining testosterone levels in men over 45 is common1 and is often the cause of erectile dysfunction (ED). Androgen deficiency, or hypogonadism, affects roughly 40% of men aged 45 or older.2
Two-thirds of these men present with symptoms. While some symptoms, like ED, indicate deficiency, additional symptoms can be similar to those of other diseases, such as cardiovascular disease.2 Tests for free, bioavailable, and total testosterone are essential to help diagnose hypogonadism and rule out other conditions. For those who may be candidates for testosterone therapy, as well as for those already on therapy, testing can also help assess and monitor testosterone levels.
What is hypogonadism?
Male hypogonadism is a clinical syndrome that results from failure of the testes to produce physiological levels of testosterone (androgen deficiency) and a normal number of spermatozoa due to disruption of one or more levels of the hypothalamic-pituitary-testicular (HPT) axis.
There are 3 types of hypogonadism3:
- Primary—testicular dysfunction leads to low levels of testosterone and high levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH)
- Secondary—dysfunction of the HPT axis results in low levels of testosterone, LH, and FSH
- Mixed—manifests a mixture of primary and secondary hypogonadism and can be observed in older men
Who should be tested for low testosterone?
Endocrine Society guidelines recommend testing patients who present with symptoms of androgen deficiency.3
Some symptoms include3:
- Reduced sexual desire (libido) and activity
- Breast discomfort (gynecomastia)
- Loss of body (axillary and pubic) hair, reduced shaving
- Very small or shrinking testes
- Inability to father children, low or zero sperm count
- Height loss, low trauma fracture, and/or low bone mineral density
- Hot flushes and sweats
- Decreased energy, motivation, initiative, and self-confidence
- Poor concentration and memory
- Reduced muscle bulk and strength
- Increased body fat
The more symptoms a patient has, the more likely he is to have low testosterone.
Other testosterone disorders supported by Quest Diagnostics testing
Women can be affected by testosterone levels as well. Hyperandrogenism is characterized by excess production of androgens by the ovaries and/or the adrenal glands.
The most common clinical manifestation of hyperandrogenism is hirsutism, or excessive terminal hair growth in androgen-dependent areas of the body. Other clinical manifestations of hyperandrogenism include acne vulgaris, weight gain, menstrual irregularities, and, in some women with polycystic ovary syndrome (PCOS), acanthosis nigricans.
Know your patients’ levels with complete testosterone testing
Quest offers a range of testosterone testing in line with Endocrine Society guidelines, to ensure accurate results for all patients.4
Quest testosterone testing options
|Test Code||Test Name||Recommended Clinical Use|
The normative ranges for total and free testosterone levels in healthy men can vary among laboratories and assays.3
- Free—not bound to any protein in the blood; most readily available to be used by the body
- Bioavailable—total amount of testosterone available to be used by the body; includes both free testosterone and testosterone that is bound to albumin
- Total—total amount of testosterone produced by the body; the most important measure when trying to understand fertility
Quest’s assays have a reportable lower limit of 250 ng/dL, consistent with that reported by other laboratories. Because levels can fluctuate day-to-day, repeat testing is recommended by the Endocrine Society prior to the initiation of treatment.3
Measurement of free or bioavailable testosterone in females offers greater sensitivity for evaluation of mild androgen excess than does total testosterone.5,6
1. Harman SM, et al. Baltimore longitudinal study of aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86:724.
2. Mulligan T, Frick MF, Zuraw QC, et al. Prevalence of hypogonadism in males aged at least 45 years: The HIM study. Int J Clin Pract. 2006;60:762–769.
3. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95:2536-59.
4. Moore C, Huebler D, Zimmermann T, et al. The Aging Males’ Symptoms scale (AMS) as outcome measure for treatment of androgen deficiency. Eur Urol. 2004;46:80-87.
5. Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: The complete task force report. Fertil Steril. 2009;91:456–488.
6. Martin KA, Chang RJ, Ehrmann DA, et al. Evaluation and treatment of hirsutism in premenopausal women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1105–1120.