Adult-Onset Hypogonadism Mohit Khera, MD, MBA, MPH, Gregory A. Broderick, MD, Culley C. Carson, MD, Adrian S. Dobs, MD, MHS, Martha M. Faraday, PhD, Irwin Goldstein, MD, Lawrence S. Hakim, MD, Wayne J.G. Hellstrom, MD, Ravi Kacker, MD, Tobias S. Köhler, MD, MPH, Jesse N. Mills, MD, Martin Miner, MD, Hossein Sadeghi-Nejad, MD, Allen D. Seftel, MD, Ira D. Sharlip, MD, Stephen J. Winters, MD, Arthur L. Burnett, MD, MBA  Mayo Clinic Proceedings  Volume 91, Issue 7, Pages 908-926 (July 2016) DOI: 10.1016/j.mayocp.2016.04.022 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Subgroups of men by gonadal status and by decade of age from the European Male Ageing Study (EMAS).4 LH = luteinizing hormone. From J Clin Endocrinol Metab,4 with permission. Mayo Clinic Proceedings 2016 91, 908-926DOI: (10.1016/j.mayocp.2016.04.022) Copyright © 2016 The Authors Terms and Conditions

Figure 2 In a group of 4220 men presenting to a sexual dysfunction clinic, only 11% of those diagnosed with secondary hypogonadism had a diagnosable medical cause for the condition.8 PRL = prolactin. Mayo Clinic Proceedings 2016 91, 908-926DOI: (10.1016/j.mayocp.2016.04.022) Copyright © 2016 The Authors Terms and Conditions

Figure 3 Medical conditions associated with secondary hypogonadism in a sample of 4220 men presenting to a sexual dysfunction clinic; 89% of men diagnosed with secondary hypogonadism did not have a diagnosable source for the condition. Most of these patients (70.7%) had a concomitant metabolic disease.8 DM2 = type 2 diabetes; MetS = metabolic syndrome. Mayo Clinic Proceedings 2016 91, 908-926DOI: (10.1016/j.mayocp.2016.04.022) Copyright © 2016 The Authors Terms and Conditions

Figure 4 Diagnostic algorithm for the man presenting with signs and symptoms of AOH. AOH = adult-onset hypogonadism; AP = anterior pituitary; Ca = cancer; DM2 = type 2 diabetes; FBC = full blood count; HL = hyperlipidemia; Hx = history; LH = luteinizing hormone; FSH = follicle-stimulating hormone; Hct = hematocrit; MRI = magnetic resonance imaging; NAFLD = nonalcoholic fatty liver disease; PRL = prolactin; SHBG = sex hormone–binding globulin; T = testosterone; TRT = testosterone replacement therapy; TT = testosterone therapy. Mayo Clinic Proceedings 2016 91, 908-926DOI: (10.1016/j.mayocp.2016.04.022) Copyright © 2016 The Authors Terms and Conditions

Figure 5 Treatment and follow-up algorithm for the patient with documented signs and symptoms of AOH who is administered TT. AOH = adult-onset hypogonadism; BMD = bone marrow density; hCG = human chorionic gonadotropin; Hct = hematocrit; LH = luteinizing hormone; FSH = follicle-stimulating hormone; PSA = prostate-specific antigen; SERM = selective estrogen receptor modulators; T = testosterone; TRT = testosterone replacement therapy; TT = testosterone therapy. Adapted from J Clin Endocrinol Metab,1 with permission. Mayo Clinic Proceedings 2016 91, 908-926DOI: (10.1016/j.mayocp.2016.04.022) Copyright © 2016 The Authors Terms and Conditions