What is the Meaning of Late-Onset Hypogonadism?

Late-Onset Hypogonadism (LOH) is a progressive clinical syndrome affecting aging men, characterized by persistently low serum testosterone concentrations accompanied by specific, non-pathognomonic symptoms. These symptoms typically include diminished libido, erectile dysfunction, reduced muscle mass and strength, increased body fat, and mood disturbances. The diagnosis is a clinical one, requiring both symptomatic presentation and biochemical confirmation of testosterone deficiency, distinguishing it from normal age-related decline.

What is the Origin of Late-Onset Hypogonadism?

The term LOH emerged in the late 20th and early 21st centuries to provide a more precise, endocrinologically accurate diagnosis than earlier, less specific terms like "andropause." This refinement was driven by a deeper clinical understanding of the complex changes in the hypothalamic-pituitary-gonadal (HPG) axis with age. The nomenclature emphasizes the acquired, rather than congenital, nature of the hormonal deficiency.

What is the Mechanism of Late-Onset Hypogonadism?

LOH can be either primary, resulting from reduced testosterone production by the Leydig cells in the testes, or secondary, caused by impaired pulsatile release of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) from the pituitary. Furthermore, aging is associated with an increase in Sex Hormone-Binding Globulin (SHBG), which further reduces the bioavailable fraction of circulating testosterone. This chronic hormonal insufficiency results in inadequate androgen receptor signaling in target tissues, leading to the constellation of clinical symptoms.

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