• Mark Livingston, Anura Kalansooriya, Andrew J Hartland, Sudarshan Ramachandran, and Adrian Heald.
• Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK.
• Int. J. Clin. Pract. 2017 Nov 1; 71 (11).

AimAlthough "late onset hypogonadism", a condition that includes low testosterone and symptoms, is common in men over the age of 40 years, diagnosis is not clear cut amongst non-specialists. It is the aim of this review to provide an up to date picture of how this state should be diagnosed and managed.MethodsWe aim to describe how primary and secondary hypogonadism should be excluded before the diagnosis of late onset hypogonadism is reached. As laboratory testosterone measurements are essential the current pitfalls such as inappropriate sample collection and the use of population derived reference ranges are expanded. We review current evidence to determine associations between late onset hypogonadism and morbidity/mortality and benefits following testosterone replacement therapy.ResultsA review of the current evidence shows that late onset hypogonadism is associated with a worse metabolic state and increased mortality. Longitudinal studies have suggested that significant reductions in both symptoms and mortality are seen, especially in patients with type 2 diabetes.DiscussionThis review highlights the importance of diagnosing late onset hypogonadism due to its association with morbidity/mortality and benefits following testosterone replacement. Thus, after making recommendations to ensure correct diagnosis we speculate whether the time has come to move away from population derived testosterone levels towards evidence based action limits.© 2017 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

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