Introduction: Hypogonadism is prevalent in older men and associated with various comorbidities. Despite this, it is underdiagnosed and undertreated.
Aim: To identify factors associated with underdiagnosis and undertreatment of male hypogonadism.
Methods: Quantitative, questionnaire-based, online survey conducted in the UK among men aged ≧40 years with hypogonadism confirmed by blood test (n=101, from N=3 871 screened respondents). All information was self-reported. The survey assessed medical history, treatment-seeking and treatment.
Results: Respondents had been diagnosed with low testosterone for a mean of 4.1 years. Prior to diagnosis, they most commonly experienced decreased libido (65%), tiredness/fatigue (64%), erectile dysfunction (ED; 59%), and listlessness/no energy (48%). Two-thirds of respondents experienced symptoms for up to 2 years before seeking advice. The main reasons for this were a belief that it was not a serious problem (49%), it was part of life (46%) or a normal consequence of ageing (44%), and/or embarrassment (41%). The key driver for treatment-seeking was a sexual health problem (ED: 31%, decreased libido: 13%). Only 16% of men suspected they had hypogonadism prior to testing, based on discussions with their partner/spouse (38%), internet research (31%), or reading about it in a magazine (25%). Over half of men (53%) reported that it was their GP who recommended a testosterone test. A fifth of men had to wait 24 weeks for this, following their initial consultation. Reasons men gave for this delay included their GP pursuing an alternative diagnosis and lack of available facilities. Importantly, almost one-quarter of men aged ≧40 years, and 40% of those aged ≧60 years, never received treatment for their hypogonadism.
Conclusions: Low testosterone is under-recognised, and misperceptions and embarrassment can discourage men from seeking help. A substantial proportion of men are untreated following a correct diagnosis, highlighting the need for improved awareness and management of this condition.