Nelson Vergel
Founder, ExcelMale.com
Although the measurement of serum testosterone levels is commonly used in the diagnosis of male HG, the cut-off values for low testosterone are not well defined and vary throughout the literature, ranging from 200–400 ng/dL, with 300 ng/dL being the most commonly utilized in clinical practice. Other measurements such as FT may also be used. Although cut-off is an important component in diagnosing HG, guidelines from the United States Endocrine Society define HG as symptoms of HG with TT <300 ng/dL, which differs from the cut-off of 249 ng/dL recommended by the European Association for Urology (10,26).
A summary of the global prevalence of TD and HG can be seen in Table 1. The prevalence of TD in middle-aged to elderly men in the United States ranged from 24–39%—a prevalence much higher than that observed in other parts of the world (4,15,27,28). This prevalence dropped to 6% when Araujo et al. evaluated HG by applying the combination of a TT threshold of 200 ng/dL and the presence of three patient-reported symptoms of HG (15), demonstrating that there is a significant difference between biochemical and clinical HG. The prevalence of diagnosed HG in Europe was significantly lower than in the US, ranging from 8–20% (9,29-31), but again appeared to be significantly lower when only diagnosed in patients with both low testosterone as well as symptoms of androgen deficiency (32). Studies in Asia and South America demonstrated a similar trend, with the prevalence of biochemical HG ranging from 17–33%, but dropping to just half of that (10–12%) when requiring the presence of relevant symptoms (3,9,33-35). HG data is lacking in Middle-Eastern populations, but studies from Jordan and Saudi Arabia (S-Arabia) showed a prevalence of 8–24% (29,36). Prevalence data in Africa was scarce, and the literature was clouded by the existence of comorbid diseases such as diabetes mellitus. Overall, although the United States seems to have a higher prevalence of diagnosed HG, prevalence rates are likely similar to other geographic locations.
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A summary of the global prevalence of TD and HG can be seen in Table 1. The prevalence of TD in middle-aged to elderly men in the United States ranged from 24–39%—a prevalence much higher than that observed in other parts of the world (4,15,27,28). This prevalence dropped to 6% when Araujo et al. evaluated HG by applying the combination of a TT threshold of 200 ng/dL and the presence of three patient-reported symptoms of HG (15), demonstrating that there is a significant difference between biochemical and clinical HG. The prevalence of diagnosed HG in Europe was significantly lower than in the US, ranging from 8–20% (9,29-31), but again appeared to be significantly lower when only diagnosed in patients with both low testosterone as well as symptoms of androgen deficiency (32). Studies in Asia and South America demonstrated a similar trend, with the prevalence of biochemical HG ranging from 17–33%, but dropping to just half of that (10–12%) when requiring the presence of relevant symptoms (3,9,33-35). HG data is lacking in Middle-Eastern populations, but studies from Jordan and Saudi Arabia (S-Arabia) showed a prevalence of 8–24% (29,36). Prevalence data in Africa was scarce, and the literature was clouded by the existence of comorbid diseases such as diabetes mellitus. Overall, although the United States seems to have a higher prevalence of diagnosed HG, prevalence rates are likely similar to other geographic locations.
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