The good, the bad, and the unknown of late onset hypogonadism: the urological perspective

The evaluation and treatment of late-onset hypogonadism (LOH) is one of the manifold tasks of the urologist in daily practice. Diagnosis of LOH is based on an adequate history and physical examination as well as biochemical assessment of androgen deficiency. Treatment of hypogonadism with androgen therapy has been shown to be highly effective in re-establishing normal testosterone levels and maintaining libido, sexual function and improving muscle mass and bone mineral density. Recent pharmacological research has developed short-acting testosterone gel preparations and a 3-month depot injection. The possible development or unmasking of prostate cancer has long been a major concern in treating LOH. Consequently underlying prostate disease should be excluded by diagnostic measures before androgen therapy is initiated. Evidence suggests that provided hypogonadal men are carefully counselled and closely monitored during treatment testosterone therapy can be initiated after radical prostatectomy for non-metastatic prostate cancer with undetectable prostate specific antigen of long duration.