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Predicting low testosterone in aging men: a systematic review.

Publication ,  Journal Article
Millar, AC; Lau, ANC; Tomlinson, G; Kraguljac, A; Simel, DL; Detsky, AS; Lipscombe, LL
Published in: Cmaj
September 20, 2016

BACKGROUND: Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men. We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men. METHODS: We searched the MEDLINE and Embase databases (January 1966 to July 2014) for studies that compared clinical features with a measurement of serum testosterone in men. Three of the authors independently reviewed articles for inclusion, assessed quality and extracted data. RESULTS: Among 6053 articles identified, 40 met the inclusion criteria. The prevalence of low testosterone ranged between 2% and 77%. Threshold testosterone levels used for reference standards also varied substantially. The summary likelihood ratio associated with decreased libido was 1.6 (95% confidence interval [CI] 1.3-1.9), and the likelihood ratio for absence of this finding was 0.72 (95% CI 0.58-0.85). The likelihood ratio associated with the presence of erectile dysfunction was 1.5 (95% CI 1.3-1.8) and with absence of erectile dysfunction was 0.83 (95% CI 0.76-0.91). Of the multiple-item instruments, the ANDROTEST showed both the most favourable positive likelihood ratio (range 1.9-2.2) and the most favourable negative likelihood ratio (range 0.37-0.49). INTERPRETATION: We found weak correlation between signs, symptoms and testosterone levels, uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition. It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men.

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Published In

Cmaj

DOI

EISSN

1488-2329

Publication Date

September 20, 2016

Volume

188

Issue

13

Start / End Page

E321 / E330

Location

Canada

Related Subject Headings

  • Testosterone
  • Prevalence
  • Middle Aged
  • Male
  • Likelihood Functions
  • Libido
  • Hypogonadism
  • Humans
  • General & Internal Medicine
  • Erectile Dysfunction
 

Citation

APA
Chicago
ICMJE
MLA
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Millar, A. C., Lau, A. N. C., Tomlinson, G., Kraguljac, A., Simel, D. L., Detsky, A. S., & Lipscombe, L. L. (2016). Predicting low testosterone in aging men: a systematic review. Cmaj, 188(13), E321–E330. https://doi.org/10.1503/cmaj.150262
Millar, Adam C., Adrian N. C. Lau, George Tomlinson, Alan Kraguljac, David L. Simel, Allan S. Detsky, and Lorraine L. Lipscombe. “Predicting low testosterone in aging men: a systematic review.Cmaj 188, no. 13 (September 20, 2016): E321–30. https://doi.org/10.1503/cmaj.150262.
Millar AC, Lau ANC, Tomlinson G, Kraguljac A, Simel DL, Detsky AS, et al. Predicting low testosterone in aging men: a systematic review. Cmaj. 2016 Sep 20;188(13):E321–30.
Millar, Adam C., et al. “Predicting low testosterone in aging men: a systematic review.Cmaj, vol. 188, no. 13, Sept. 2016, pp. E321–30. Pubmed, doi:10.1503/cmaj.150262.
Millar AC, Lau ANC, Tomlinson G, Kraguljac A, Simel DL, Detsky AS, Lipscombe LL. Predicting low testosterone in aging men: a systematic review. Cmaj. 2016 Sep 20;188(13):E321–E330.

Published In

Cmaj

DOI

EISSN

1488-2329

Publication Date

September 20, 2016

Volume

188

Issue

13

Start / End Page

E321 / E330

Location

Canada

Related Subject Headings

  • Testosterone
  • Prevalence
  • Middle Aged
  • Male
  • Likelihood Functions
  • Libido
  • Hypogonadism
  • Humans
  • General & Internal Medicine
  • Erectile Dysfunction