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Mechanisms of Disease: late-onset hypogonadism

Nature Clinical Practice Urology volume 3, pages 430–438 (2006)Cite this article

Abstract

Late-onset hypogonadism (formerly called the andropause) is a clinical and biochemical syndrome associated with advancing age, which is characterized by typical signs and symptoms and a deficiency in serum testosterone levels. Age-related hypoandrogenism in the male is a result of the interaction of hypothalamopituitary and testicular factors. The hypothalamic pulsatile secretion of gonadotropin-releasing hormone is blunted, due to increased hypothalamic sensitivity to inhibition by steroids, but the responsiveness of the pituitary gonadotrophs seems to be intact. In addition, testicular volume as well as Leydig cell mass and reserve function are diminished. Taken together, these mechanisms result in reduced testosterone secretion and the loss of nycthemeral variability.

Key Points

  • Late-onset hypogonadism (LOH) results from the interaction of hypothalamic, pituitary and testicular factors

  • In men with LOH, the hypothalamic pulsatile secretion of gonadotropin-releasing hormone is reduced

  • Testicular Leydig cell mass and reserve function are diminished in men with LOH

  • Underlying endocrine mechanisms result in reduced testosterone secretion and the loss of nycthemeral variability

  • Many systemic, pathologic conditions are epidemiologically linked to LOH; whether these are a cause or a result of LOH is unclear, and in some cases the relationship may be bidirectional (e.g. obesity)

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Figure 1: Hormonal regulation of testicular function and spermatogenesis

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Authors and Affiliations

  1. certified Clinical Andrologist from the European Academy of Andrology, and a doctor in medical sciences,

    Ahmed Mahmoud & Frank H Comhaire

  2. Professor and Andrologist based in the Department of Medical and Urological Andrology, Ghent University Hospital, Ghent, Belgium

    Ahmed Mahmoud & Frank H Comhaire

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Correspondence to Ahmed Mahmoud.

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Mahmoud, A., Comhaire, F. Mechanisms of Disease: late-onset hypogonadism. Nat Rev Urol 3, 430–438 (2006). https://doi.org/10.1038/ncpuro0560

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