ArticleThe New England journal of medicine2010
Identification of late-onset hypogonadism in middle-aged and elderly men.
Article in The New England journal of medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 472 papers, 10 of them syntheses that pooled it.
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The trial behind it
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Who cites it
472 citing papers in PubMed, 10 syntheses or guidelines pooled it, 1,501 citations in OpenAlex.
- Metabolic Effects of Testosterone Replacement Therapy in Men with Functional Secondary Hypogonadism, Obesity and Type 2 Diabetes or Metabolic Syndrome: A Systematic Review.Medical sciences (Basel, Switzerland) · 2026Pooled it
- Long-Term Cardiovascular Safety of Testosterone-Replacement Therapy in Middle-Aged and Older Men: A Meta-analysis of Randomized Controlled Trials.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025Pooled it
- Clomiphene or enclomiphene citrate for the treatment of male hypogonadism: a systematic review and meta-analysis of randomized controlled trials.Archives of endocrinology and metabolism · 2025Pooled it
- Effects of Tribulus (Nutrients · 2025Pooled it
- The effects and safety of testosterone replacement therapy for men with hypogonadism: the TestES evidence synthesis and economic evaluation.Health technology assessment (Winchester, England) · 2024Pooled it
- Testosterone replacement in men with sexual dysfunction.The Cochrane database of systematic reviews · 2024Pooled it
- Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE).Journal of endocrinological investigation · 2022Guideline
- Efficacy of testosterone replacement therapy for treating metabolic disturbances in late-onset hypogonadism: a systematic review and meta-analysis.International urology and nephrology · 2021Pooled it
- Pooled it
- Men's beliefs about treatment for erectile dysfunction-what influences treatment use? A systematic review.International journal of impotence research · 2021Pooled it
- A Randomized Double-Blind Placebo-Controlled Trial of a Botanical Formulation for Symptom Management in Male Climacteric Syndrome.Medicina (Kaunas, Lithuania) · 2026Trial
- Testosterone Treatment and Sexual Function in Men: Secondary Analysis of the T4DM (Testosterone for Diabetes) Trial.The Journal of clinical endocrinology and metabolism · 2025Trial
- Trial
- Dose-Response Relationships Between Gonadal Steroids and Bone, Body Composition, and Sexual Function in Aging Men.The Journal of clinical endocrinology and metabolism · 2020Trial
- Association between a novel nutritional-inflammatory index and testosterone levels: a cross-sectional study.Sexual medicine · 2026Article
- Autoimmunity and Inflammaging in Male Infertility.Clinical reviews in allergy & immunology · 2026Review
- Update on testosterone deficiency and therapeutic options for testosterone replacement therapy.Nature reviews. Urology · 2026Review
- Masculinity, Lifestyle Factors, and Andropause-Related Symptoms in Pakistani Men: A Cross-Sectional Study.Health science reports · 2026Article
- Association between changes in work environment and andropause symptoms during the COVID-19 pandemic in Japanese male workers: a cross-sectional study.Industrial health · 2026Article
- [The unbearable versatility of endocrine aging].Problemy endokrinologii · 2026Review
412 more citing papers are in PubMed but not listed here.
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Authors and funding
21 authors at 11 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe association between aging-related testosterone deficiency and late-onset hypogonadism in men remains a controversial concept. We sought evidence-based criteria for identifying late-onset hypogonadism in the general population on the basis of an association between symptoms and a low testosterone level.
methodsWe surveyed a random population sample of 3369 men between the ages of 40 and 79 years at eight European centers. Using questionnaires, we collected data with regard to the subjects' general, sexual, physical, and psychological health. Levels of total testosterone were measured in morning blood samples by mass spectrometry, and free testosterone levels were calculated with the use of Vermeulen's formula. Data were randomly split into separate training and validation sets for confirmatory analyses.
resultsIn the training set, symptoms of poor morning erection, low sexual desire, erectile dysfunction, inability to perform vigorous activity, depression, and fatigue were significantly related to the testosterone level. Increased probabilities of the three sexual symptoms and limited physical vigor were discernible with decreased testosterone levels (ranges, 8.0 to 13.0 nmol per liter [2.3 to 3.7 ng per milliliter] for total testosterone and 160 to 280 pmol per liter [46 to 81 pg per milliliter] for free testosterone). However, only the three sexual symptoms had a syndromic association with decreased testosterone levels. An inverse relationship between an increasing number of sexual symptoms and a decreasing testosterone level was observed. These relationships were independently confirmed in the validation set, in which the strengths of the association between symptoms and low testosterone levels determined the minimum criteria necessary to identify late-onset hypogonadism.
conclusionsLate-onset hypogonadism can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.