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

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.