Adult-Onset Hypogonadism

Mayo Clin Proc. 2016 Jul;91(7):908-26. doi: 10.1016/j.mayocp.2016.04.022. Epub 2016 Jun 21.


In August 2015, an expert colloquium commissioned by the Sexual Medicine Society of North America (SMSNA) convened in Washington, DC, to discuss the common clinical scenario of men who present with low testosterone (T) and associated signs and symptoms accompanied by low or normal gonadotropin levels. This syndrome is not classical primary (testicular failure) or secondary (pituitary or hypothalamic failure) hypogonadism because it may have elements of both presentations. The panel designated this syndrome adult-onset hypogonadism (AOH) because it occurs commonly in middle-age and older men. The SMSNA is a not-for-profit society established in 1994 to promote, encourage, and support the highest standards of practice, research, education, and ethics in the study of human sexual function and dysfunction. The panel consisted of 17 experts in men's health, sexual medicine, urology, endocrinology, and methodology. Participants declared potential conflicts of interest and were SMSNA members and nonmembers. The panel deliberated regarding a diagnostic process to document signs and symptoms of AOH, the rationale for T therapy, and a monitoring protocol for T-treated patients. The evaluation and management of hypogonadal syndromes have been addressed in recent publications (ie, the Endocrine Society, the American Urological Association, and the International Society for Sexual Medicine). The primary purpose of this document was to support health care professionals in the development of a deeper understanding of AOH, particularly in how it differs from classical primary and secondary hypogonadism, and to provide a conceptual framework to guide its diagnosis, treatment, and follow-up.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aging / physiology
  • Androgens / adverse effects
  • Androgens / deficiency
  • Androgens / therapeutic use
  • Comorbidity
  • Hormone Replacement Therapy / statistics & numerical data*
  • Humans
  • Hypogonadism / drug therapy*
  • Hypogonadism / epidemiology
  • Hypogonadism / physiopathology
  • Male
  • Middle Aged
  • Prevalence
  • Sexual Dysfunction, Physiological / drug therapy*
  • Sexual Dysfunction, Physiological / epidemiology
  • Sexual Dysfunction, Physiological / physiopathology
  • Testosterone / adverse effects
  • Testosterone / deficiency*
  • Testosterone / therapeutic use


  • Androgens
  • Testosterone