Late Onset Hypogonadism (LOH), also commonly referred to as age-related male hypogonadism, is a clinical syndrome characterized by a deficiency in testosterone production that develops progressively with advancing age. This hormonal decline is associated with non-specific, often subtle symptoms, including decreased libido, erectile dysfunction, reduced muscle mass, increased visceral fat, and diminished vitality. The diagnosis is confirmed by consistently low serum testosterone levels in conjunction with these clinical signs. LOH represents a complex endocrine phenomenon distinct from classical hypogonadism, often involving a mix of primary testicular failure and secondary hypothalamic-pituitary dysfunction.
Origin
The term “hypogonadism” comes from the Greek hypo (under) and gonados (seed or testicle), referring to diminished gonadal function. The descriptor “Late Onset” was added clinically to distinguish the gradual, age-related form from congenital or early-onset conditions. This terminology reflects the growing clinical recognition of this age-related endocrine shift as a treatable syndrome impacting male health and longevity.
Mechanism
The etiology is multifactorial, often combining a decrease in the number and function of Leydig cells in the testes, which is primary failure, with reduced pulsatile secretion of Gonadotropin-Releasing Hormone (GnRH) and Luteinizing Hormone (LH) from the hypothalamus and pituitary, which is secondary failure. This dual mechanism results in lower total and free testosterone levels. Furthermore, the age-related increase in Sex Hormone-Binding Globulin (SHBG) further reduces the biologically active free testosterone, contributing significantly to the clinical symptoms of hormonal deficiency.
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