Symptomatic late-onset hypogonadism but normal total testosterone: the importance of testosterone annual decrease velocity

Sandro La Vignera, Rosita A. Condorelli, Aldo E. Calogero, Rossella Cannarella, Laura M. Mongioì, Ylenia Duca, Laura Cimino, Filippo Giacone, Antonio Aversa


Several lines of evidence suggest that a decline of serum testosterone levels occur in the aging male. This condition is called late-onset hypogonadism (LOH). Current guidelines suggest testosterone replacement therapy (TRT) when total testosterone (TT) is lower than 9.2 nmol/L. However, the clinical management of patients showing signs and symptoms suggestive for LOH but with TT in the lowest quartile of the normal range and/or having higher than the expected testosterone annual reduction velocity is not covered. This editorial aims to discuss this hot topic, suggesting a possible management.