Age-Related Hypogonadism: Age Threshold
Age-related hypogonadism is not defined by a specific age cutoff, but rather by the gradual decline in testosterone that begins in men's mid-30s and continues at approximately 1.6% per year, with clinical significance increasing substantially after age 60. 1
Age-Related Prevalence Patterns
The American College of Physicians provides clear epidemiological data showing the age-dependent increase in low testosterone prevalence: 1
- Approximately 20% of men older than 60 years have low testosterone levels
- 30% of men older than 70 years have low testosterone levels
- 50% of men older than 80 years have low testosterone levels
These statistics demonstrate that age-related hypogonadism becomes increasingly common with advancing age, but there is no single age threshold that defines when it "begins." 2
Physiological Timeline
Testosterone decline starts in the mid-30s and progresses continuously throughout life at an average rate of 1.6% per year. 1 This gradual decline means that age-related hypogonadism (also termed late-onset hypogonadism or LOH) is a progressive condition rather than one with a discrete onset age. 1
Clinical Significance vs. Age Alone
Age itself is NOT an indication for testing or diagnosis. 2, 3 The diagnosis of age-related hypogonadism requires BOTH: 1
- Persistent specific symptoms (particularly sexual symptoms like decreased libido, erectile dysfunction, or reduced spontaneous erections)
- Confirmed biochemical testosterone deficiency on morning testing
Approximately 30% of men in their 60s and more than 80% of men over 80 years may have a low free testosterone index, but this biochemical finding alone without symptoms does not constitute a diagnosis. 4
Important Clinical Caveats
Do not test testosterone in asymptomatic older men simply because of age. 2, 3 The presence of low testosterone levels increases with age, but the prevalence of true symptomatic hypogonadism (syndromic low testosterone defined as at least 3 sexual symptoms with total testosterone <11.1 nmol/L or 320 ng/dL) is much lower—approximately 2% of community-dwelling men aged 40-80 years. 1, 5
The uncertainty exists whether nonspecific signs and symptoms in older men are consequences of low testosterone or result from other factors such as chronic illnesses, medications, or obesity. 1 This is why the condition is increasingly referred to as "functional hypogonadism" rather than simply age-related hypogonadism, as obesity and comorbidities often play larger roles than chronological age. 5