Question

Discuss androgen deficiency in aging male:
Diagnostic evaluation and confirmation of diagnosis.

Hint:

Confirm low testosterone levels with repeat testing before starting treatment, and consider other causes for symptoms.

Answer 1

Androgen deficiency in aging males is a condition characterized by low testosterone levels that affect physical and psychological well-being.
Step 1: Clinical Symptoms:
- Symptoms may include fatigue, decreased libido, erectile dysfunction, reduced muscle mass, depression, and osteoporosis.
- Screening for symptoms should be performed using validated questionnaires, such as the Androgen Deficiency in Aging Male (ADAM) questionnaire or the Aging Male Symptoms (AMS) scale.
Step 2: Blood Tests:
- The diagnosis is confirmed by measuring total serum testosterone levels. A low testosterone level is generally defined as below 300 ng/dL.
- Blood tests should be performed in the morning (7 AM to 10 AM) when testosterone levels are highest. If initial levels are low, confirmatory tests should be done on a separate day.
- Free testosterone levels can also be measured, especially in patients with obesity or altered binding proteins.
Step 3: Additional Testing:
- Measure luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels to differentiate between primary hypogonadism (testicular failure) and secondary hypogonadism (pituitary or hypothalamic dysfunction).
- Prolactin levels may also be measured to rule out pituitary disorders.