symptoms evaluated (libido and poor erectile function)

predicted a low TT level.

A large general population of community dwelling men aged

–

79 years was evaluated in the EMAS [7]. The EMAS

reported two important

ﬁ

ndings. First, sexual symptoms, such

as ED and low libido, were most closely associated with low

testosterone. Second, the TT threshold below which these

sexual symptoms became more prevalent varied from 320 to

350 ng/dL. Although poor erectile function and low libido

were among the most common symptoms seen in our present

study, the presence of these symptoms did not predict TT

levels of

400 ng/dL (Table 2). Although sexual symptoms

may be a good indicator of low testosterone in community

dwelling middle-aged, and elderly men, they remain a poor

indicator for identifying low testosterone in men aged

40 years attending a men

’

s health clinic. The cluster of

symptoms that predict a low testosterone in young men

suggests that appropriate age and population-based questions

need to be asked before initiating hypogonadism treatment.

In most men, serum TT concentrations of

300 ng/mL

indicate that there is a low likelihood of clinically signi

ﬁ

cant

androgen de

ﬁ

ciency. Threshold TT levels were calculated on

the basis of symptoms for which the probability was

signi

ﬁ

cantly increased among men with a decreased TT level,

as compared with men who had an increased level of TT. No

thresholds were identi

ﬁ

ed for sexual symptoms associated

with TT. When evaluating prevalence of symptoms at the

often-used TT threshold of 300 ng/dL, we did not

ﬁ

nd a

signi

ﬁ

cant difference between men. In our clinical experience,

many patients with serum TT levels between 300 and

400 ng/dL, still report hypogonadal symptoms. Due to this

discrepancy between standard practice and clinical experience,

Table 1

Probability of hypogonadal symptoms on the basis of levels of serum total testosterone (TT).