What Are the Current Guidelines for Diagnosing and Treating Late-Onset Hypogonadism?

Reviewed by Garrett Kneese, MD, MPH

Family Medicine

Current guidelines recommend diagnosing late-onset hypogonadism based on both consistent clinical symptoms and confirmed low testosterone levels measured in the morning, and treatment generally involves careful testosterone therapy with regular monitoring.

Explanation

For diagnosing late-onset hypogonadism, clinicians start with a detailed check of symptoms like low energy, reduced sexual desire, and mood changes. They then measure testosterone levels—usually in the morning on two separate visits—to verify that levels are consistently low. Many guidelines suggest using total testosterone levels (often below about 300 ng/dL) along with free testosterone measurements if needed. A full medical work-up helps rule out other causes and assess for any conditions that might make testosterone therapy unsafe. When it comes to treatment, testosterone replacement therapy is usually recommended only if there are clear symptoms and confirmed low hormone levels. Before starting therapy, doctors review potential risks, including prostate health and blood count issues, and plan regular follow-ups to track the benefits and any side effects. These steps help ensure that treatment is safe and effective. Different regions have slight variations in recommendations, but the overall approach—symptom evaluation, confirmatory lab tests, and careful therapy with monitoring—remains consistent.

(References)

Huhtaniemi I. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment. Asian J Androl. 2014 Mar-Apr;16(2):192-202. doi: 10.4103/1008-682X.122336. PMID: 24407185; PMCID: PMC3955328.
Amano T. Late-onset hypogonadism: current methods of clinical diagnosis and treatment in Japan. Asian J Androl. 2025 Jan 28. doi: 10.4103/aja2024111. Epub ahead of print. PMID: 39887188.
Kalra S, Jacob J, Unnikrishnan AG, Bantwal G, Sahoo A, Sahay R, Jindal S, Agrawal MS, Kapoor N, Saboo B, Tiwaskar M, Kochhar K. Expert Opinion on the Diagnosis and Management of Male Hypogonadism in India. Int J Endocrinol. 2023 Feb 22;2023:4408697. doi: 10.1155/2023/4408697. PMID: 36876281; PMCID: PMC9977550.
Al-Sharefi A, Quinton R. Current National and International Guidelines for the Management of Male Hypogonadism: Helping Clinicians to Navigate Variation in Diagnostic Criteria and Treatment Recommendations. Endocrinol Metab (Seoul). 2020 Sep;35(3):526-540. doi: 10.3803/EnM.2020.760. Epub 2020 Sep 22. PMID: 32981295; PMCID: PMC7520594.

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