Late-Onset Hypogonadism (LOH)

What is Late-Onset Hypogonadism?

Late-onset hypogonadism (LOH) is characterized by a progressive decline in blood testosterone levels associated with advancing age in men.

Unlike female menopause — which involves a sudden and complete halt in hormone production and fertility —, this condition in men occurs slowly, insidiously, and gradually, which is why the popularly used term “andropause” is not appropriate. From the age of 30 to 40, total testosterone levels undergo a natural physiological decline of about 1% per year. In many men, this decline does not cause problems, but when hormone levels fall below the healthy threshold, clinical symptoms with systemic impact begin to appear.

Clinical Symptoms of Testosterone Deficiency

Testosterone plays a vital role in multiple organs of the male body. LOH manifests through a triad of physical, sexual, and psychological symptoms:

Sexual Symptoms

  • Marked decrease in sexual desire (loss of libido);
  • Erectile dysfunction (difficulty achieving or maintaining rigidity);
  • Drastic reduction or absence of spontaneous morning erections.

Physical and Metabolic Symptoms

  • Deep fatigue, unexplained tiredness, and loss of vital energy;
  • Decrease in muscle mass and strength;
  • Increase in body fat, especially in the abdominal area;
  • Osteoporosis or osteopenia (loss of bone mineral density, increasing the risk of fractures).

Psychological and Cognitive Symptoms

  • Mood changes, increased irritability, or depressive tendencies;
  • Difficulty concentrating and memory lapses;
  • Sleep pattern disturbances (insomnia or excessive daytime sleepiness).
Accurate Laboratory Diagnosis

The diagnosis of LOH can never be based on symptoms alone (which are common to stress and general aging). It requires confirmation through specific blood tests.

  • Blood tests to measure Total Testosterone, Free Testosterone, and SHBG must be taken in the **morning (between 8:00 AM and 11:00 AM)**, when hormone levels reach their natural daily peak.
  • For a definitive diagnosis, low values must be confirmed in at least two separate tests over time, while also ruling out other causes such as thyroid disease or hyperprolactinemia.
Treatment: Testosterone Replacement Therapy (TRT)

In cases where the hormone deficiency is clinically and laboratorially confirmed, **Testosterone Replacement Therapy (TRT)** offers extraordinary benefits in restoring vitality and overall health in men.

The main modern methods of administration include:

  • Transdermal Testosterone Gel: Applied daily by the patient to clean skin on the shoulders or abdomen. Provides stable absorption and mimics the body’s natural biological rhythm.
  • Long-Acting Intramuscular Injections; Administered by a healthcare professional every 4 to 12 weeks, depending on the formulation. Ensures adequate hormone levels without the need for daily care.

Safety and Medical Monitoring: TRT is a safe medical treatment, but it requires rigorous urological monitoring. Before and during treatment, the urologist must periodically assess hemoglobin levels (risk of polycythemia), liver function, and prostate status through a digital rectal exam and **PSA** testing. TRT does not cause prostate cancer; however, prior exclusion of existing cancer is recommended.

Have you been feeling a loss of energy, constant fatigue, and a decline in sexual desire lately?
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