Hypogonadal symptoms in young men are
associated with a serum total testosterone
threshold of 400 ng/dL
Jason M. Scovell, Ranjith Ramasamy, Nathan Wilken, Jason R. Kovac and Larry I.
Department of Urology, Baylor College of Medicine, Houston, TX, USA
To investigate the association between hypogonadal
symptoms and serum total testosterone (TT) levels in
young men (aged
40 years), in an attempt to determine
whether there exists a clear-cut discriminatory threshold of
TT below which hypogonadal symptoms become more
Patients and methods
We retrospectively reviewed the charts of 352 men who
presented to an outpatient Men
s Health Clinic with chief
complaint of
low testosterone
. Sexual, psychological and
physical symptoms were evaluated using the Androgen
ciency in Aging Male (ADAM) questionnaire. Serum
levels of TT were collected on the same day that men
completed their ADAM questionnaires. We subsequently
performed univariate (
-test, chi-square) and multivariate
analyses (ordinal logistic regression) to evaluate factors that
predicted a low TT level.
The probability of hypogonadal symptoms increased at a serum
TT level of 400 ng/dL. A cluster of symptoms: two psychological
decreased energy
), and three physical (
strength and endurance
decreased ability to play sports
deterioration in work performance
) were most strongly
associated with serum TT levels of
400 ng/dL. On multivariable
analysis, only
lack of energy
predicted a TT level of
400 ng/dL.
Hypogonadal symptoms in men aged
40 years can be
associated with a TT level of
400 ng/dL. Of the hypogonadal
symptoms evaluated with the ADAM questionnaire,
lack of
appears to be the most important symptom that
predicts a TT level of
400 ng/dL.
libido, erectile dysfunction, ADAM, androgen de
ageing male
Hypogonadism is a clinical disorder consisting of a cluster of
symptoms in the presence of low serum levels of total
testosterone (TT), traditionally de
ned as a solitary threshold
value of
300 ng/dL [1]. It is important to note that the TT
threshold of 300 ng/dL was solely determined via panel
consensus by the Endocrine Society [2] and based upon
observational studies. Several other societies have suggested
varying testosterone thresholds from 230 to 350 ng/dL [3].
The uniform application of a single serum threshold to de
hypogonadism is not appropriate given that men can exhibit
different symptoms at different serum TT levels [4]. Studies
surveying population-based cohorts, e.g. the Men in Australia
Telephone Survey (MATeS) [5], the Massachusetts Male
Aging Study (MMAS) [6], or the European Male Ageing
Study (EMAS) [7], provide useful information about the
prevalence and incidence of hypogonadal symptoms in
community dwelling men. However, these cohorts do not
represent men who are actually seeking diagnosis and
possible treatment. Consequently, it is of paramount
importance to assess the symptom pro
les of young patients
to provide physicians with necessary tools for adequate
management. Another important issue is that we are not
certain what thresholds should be used for the de
nition of
testosterone de
ciency in men of any age.
To our knowledge, this is the
rst study to evaluate the
association between TT levels and hypogonadal symptoms in
young men. Given the increasing prevalence of testosterone
use among men of all ages [8], it is important to understand
hypogonadal symptomatology in young men whose chief
complaint is
low testosterone
. Therefore, we conducted a
study in young men who presented with a chief complaint of
low testosterone
or symptoms of hypogonadism.
These men had never received testosterone supplementation
therapy (TST) allowing us to speci
cally characterise the
2014 The Authors
BJU International
2014 BJU International | doi:10.1111/bju.12970
Published by John Wiley & Sons Ltd. www.bjui.org
Sexual Medicine