[Relevant clinical and biological criteria for the diagnosis of androgen deficiency in the aging male (ADAM)]

Abstract

Introduction: The androgen deficiency in the aging male (ADAM) affects 30 % of men after 70. It's responsible for many minor symptoms but also major complications. The objective of this study was to establish the clinical and biological criteria for the diagnosis of ADAM.

Material and method: Data on clinical and biological criteria for the diagnosis of ADAM have been explored in Medline and Embase using the MeSH keywords: androgen deficiency; testosterone deficiency; late-onset hypogonadism; aging. The articles were selected based on their methodology, relevance, date and language of publication. RELEVANT CLINICAL CRITERIA FOR THE DIAGNOSIS OF ADAM: The prevalence of symptomatic ADAM in the old male ranges from 6 % to 12 %. The main clinical manifestations of ADAM include various sexual disorders associated with many nonspecific symptoms which can even be present without androgen deficiency. ADAM may induce type 2 diabetes or some cardiovascular complications which increase the risk of death. Because of low specificity, the use of diagnostic tools is not recommended to screen ADAM. VARIATION IN THE ANDROGEN SECRETION DURING AGING: The annual decrease rate of testosterone is 1.6 % after 30 leading to androgen deficiency in 50 % of patients after 80. ADAM is due to a concomitant reduction of testosterone and gonadotropin secretion. RELEVANT BIOLOGICAL CRITERIA FOR THE DIAGNOSIS OF ADAM: The biological diagnosis of androgen deficit is based on two determinations of total testosterone obtained between 7 AM and 11 AM. Levels below 8 nmol/L are an indication to hormonal substitution while patients with levels above 12 nmol/L don't seem to benefit from this type of treatment. Between 8 and 12 nmol/L, it is recommended to assess free testosterone levels. Because of a decrease in gonadotrophin secretion during aging, the LH levels are abnormally normal in ADAM.

Conclusion: ADAM is a biological and clinical syndrome characterized by the association of nonspecific symptoms and decrease testosterone levels. Hormone replacement therapy appears to benefit patients at risk of metabolic, cardiovascular or bone complications.