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Overview Of Hypogonadism
Prevalence
Although hypogonadism is a relatively common disorder, the exact prevalence is uncertain. However, it is clear that hypogonadism affects a significant proportion of the aging male population and its incidence can be expected to increase as a result of the aging population, increased life expectancy, and the increasing prevalence of type 2 diabetes mellitus, metabolic syndrome, obesity, and other risk factors for hypogonadism.
Using the standardized and widely-used AMS scale, the prevalence of moderate-to-severe hypogonadism was estimated at approximately 20% in European men aged over 50 years.1 Thus, in the European Union, approximately 81 million men aged 50 years and over are at risk of hypogonadism.
The AMS (Aging Males’ Symptoms) scale is a 17-point self-rating questionnaire designed to help assess the symptoms of testosterone deficiency and monitor treatment-related changes if a diagnosis of hypogonadism is confirmed and testosterone replacement therapy initiated. Access the questionnaire.
81 million men aged 50 years and over are at risk of hypogonadism (Table 1). When hypogonadism is defined on the basis of a combination of testosterone and signs and symptoms according to the current Endocrine Society guidelines2, other population-based studies have estimated an overall prevalence in men aged 30 years and over of 5.6%, rising to 18.4% among 70-year olds.3 Approximately 40% of men aged 45 years or over (mean age 60.5 years; range 45–96 years) screened in primary care had hypogonadism (defined as testosterone <300 ng/dL), with significantly higher rates in men with hypertension, hyperlipidemia, obesity, diabetes, prostate disease, and asthma or chronic obstructive pulmonary disease.4 However, despite hypogonadism affecting a substantial proportion of the adult male population, only a small proportion are being treated for hypogonadism and, according to independent medical policy analysis, the condition is probably underdiagnosed.5
| Region | Age 50–64 | Age 65–79 | Age 80+ |
|---|---|---|---|
| Whole European Union | 42.53 | 29.61 | 9.63 |
| France | 5.32 | 3.45 | 1.36 |
| Germany | 6.48 | 5.21 | 1.58 |
| Ireland | 0.33 | 0.17 | 0.04 |
| Italy | 5.23 | 4.17 | 1.46 |
| Spain | 3.44 | 3.25 | 1.23 |
| United Kingdom | 4.99 | 3.26 | 1.23 |
| Figures from Carruthers M. The Aging Male 2009; 12(1):21-28 | |||
Note, this is modified from table 1, page 23 Carruthers M. The Aging Male
References:
1. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91(6): 1995-2010.
2. Heinemann LA. Aging Males' Symptoms scale: a standardized instrument for the practice. J Endocrinol Invest 2005; 28(11 Suppl Proceedings): 34-8(5): 507-514.
3. Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab 2007; 92(11): 4241-7.
4. Mulligan T, Frick MF, Zuraw QC, et al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract 2006; 60(7): 762-9.
5. Liverman CT, Blazer DG, Editors. Testosterone and Aging: Clinical Research Directions. Washington, DC, USA: Institute of Medicine of the National Academies; 2003 November 11, 2003.
