INTERPRETATION We found weak correlation between signs , symptoms and testosterone levels , uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition .
It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men
BACKGROUND Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men .
We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men .
Serum testosterone levels in diabetic men with and without erectile dysfunction
Diabetes mellitus is a common chronic disease , affecting 0.5–2 % worldwide . The Massachusetts Male Aging Study reported that up to 75 % of men with diabetes have a lifetime risk of developing ED . Type 2 diabetes is associated with low total serum testosterone ( TT ) identified in several cross‐sectional studies and systemic analyses . There is a lack of consensus regarding what constitutes the lowest level of testosterone within the boundaries of normality . In this retrospective study , we sought to evaluate the effect of associated co‐morbidities on serum total testosterone ( TT ) level in men with type 2 diabetes DM , either with or without erectile dysfunction ( ED ) . Three hundred and ninety‐one patients were evaluated for erectile function  using an abridged , five‐item version of the International Index of Erectile Function‐5 . Measurements of TT , fasting lipid profile , blood sugar and glycated haemoglobin ( HbA1c ) were conducted . Penile hemodynamics was assessed using intracavernosal injection and penile duplex study .  Hypogonadism was found in 126 cases ( 33.2 % ) , and normal TT was observed in 254 ( 66.8 % ) . ED was detected in 119 cases in the hypogonadal group ( 94.4 % ) as compared to 155/254 ( 61.0 % ) in eugonadal group , P = 0.0001 . TT was lower in diabetic men with ED as compared to those with normal erectile function ( EF ) , 392.4 ± 314.9 versus 524.3 ± 140.2 ng dl−1 , respectively , P < 0.0001 . After exclusion of patients with hypertension and dyslipidaemia , 185 men were evaluated , and there was no difference in the mean TT level among men with ED 490.6 ± 498.2 ng dl−1 versus normal EF 540.6 ± 133.4 ng dl−1 although , HbA1c remained lower in men with normal erectile function . Receiver operating characteristic ( ROC ) curve of TT in men without associated co‐morbidities showed that EF was compromised at TT = 403.5 ng dl−1 or less . Sensitivity of 63.3 % and a specificity of 94.0 % were detected . At this level , ED was found in 33/38 ( 86.8 % ) men with TT 403.5 ng dl−1 , whereas ED was observed in 57/147 ( 38.8 % ) men with TT ≥ 403.5 ng dl−1 ( P < 0.0001 ) . We propose a cut‐off value of 403.5 ng dl−1 of TT blood levels as an indicator for initiation of testosterone replacement therapy in diabetic men with ED . Further prospect i ve controlled trials are recommended
INTERPRETATION We found weak correlation between signs , symptoms and testosterone levels , uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition .
It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men
BACKGROUND Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men .
We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men .