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Late-Onset Hypogonadism (LOH / DALA) in Paris

Dr Adam Vardi - Urologist

Appointment

Testosterone deficiency in the ageing man

Management of late-onset hypogonadism in Paris

Testosterone deficiency in the ageing man — medically termed late-onset hypogonadism (LOH; in French DALA, “Déficit Androgénique Lié à l’Âge”) — is a clinical and biological entity characterised by a decrease in testicular testosterone production and, in some cases, by alteration of pituitary regulation.

Unlike menopause in women, which is an abrupt and universal cessation of ovarian function, LOH is a gradual process that does not affect all men in the same way. The role of the urologist-andrologist is to distinguish what is part of normal physiological ageing from what constitutes a pathological deficiency requiring substitution therapy.

Physiology and role of testosterone

Urological Surgery in Paris & Neuilly

Testosterone is the principal androgen hormone in men. Produced by the Leydig cells in the testes under the control of the hypothalamic-pituitary axis, it has pleiotropic (multiple) effects on the body. It is involved not only in sexual function and reproduction, but also in the maintenance of bone density, the development of muscle mass, fat distribution, red blood cell production, and mood regulation.

With age, a decrease in total testosterone of approximately 1% per year is observed from the age of 40. However, it is bioavailable testosterone (the fraction of the hormone active and not bound to transport proteins) that best reflects the patient’s actual hormonal status.

Clinical manifestations of LOH

Dr. Adam Vardi - Urologist in Paris

The diagnosis of LOH is complex because its symptoms are often non-specific and may be confused with other conditions (depression, metabolic syndrome, and chronic fatigue). Symptoms are grouped into three main categories:

  • Sexual symptoms: the most evocative sign. It manifests as a decrease in sexual desire (libido), a reduction in spontaneous morning erections, and erectile dysfunction.

  • Physical symptoms: decrease in strength and muscle mass (sarcopenia), increase in abdominal fat, unexplained fatigue, sleep disorders, and, in the longer term, osteoporosis.

  • Psychological symptoms: irritability, lower motivation, difficulty concentrating, and tendency towards sadness or anxiety.

Diagnosis of late-onset hypogonadism in Paris

Dr. Vardi - Urologist in Neuilly & Paris

Biological diagnosis: an essential rigor

A diagnosis of LOH cannot be made based on symptoms alone. It must be confirmed by rigorous biological tests.

  • Testosterone assay: the sample must imperatively be taken in the morning (between 8 and 10 a.m.), when the circadian peak of the hormone is at its maximum.
  • Confirmation: if the level is low, a second assay is required to confirm the deficiency. Total testosterone is usually measured, along with the transport protein (SHBG) or bioavailable testosterone.
  • Additional work-up: Dr Vardi also prescribes assays of pituitary hormones (LH, FSH) to determine whether the deficiency is of testicular (primary) or central (secondary) origin.

Therapeutic management and substitution therapy

The aim of treatment is to restore physiological testosterone levels to improve quality of life and prevent the risks associated with deficiency (notably osteoporosis and metabolic risks).

The various forms of substitution

  • Transdermal gels: daily application to the shoulders or abdomen. This method offers a stable hormonal concentration close to physiology.
  • Intramuscular injections: administered at regular intervals (every few weeks or every three months depending on formulation).
  • Oral treatments: less commonly used due to more irregular absorption. They are not available in France.

Contraindications and safety

Before any prescription, a complete urological work-up is essential. Testosterone treatment does not cause prostate cancer, but it could stimulate its growth if it is already present. Consequently, a PSA assay and digital rectal examination are systematically performed before and during treatment. Other contraindications include male breast cancer and severe polycythemia (excess of red blood cells).

Medical follow-up and expected benefits

Follow-up visits with the urologist are scheduled every three months during the first year, and then annually. These visits allow for dose adjustments and monitoring of treatment tolerance (liver function tests, red blood cell count, and prostate monitoring).

The benefits of treatment become apparent gradually:

  • Improvements in libido and psychological well-being are often noticed within the first few weeks.
  • Effects on body composition (muscle mass and fat) and bone density generally require several months of continuous treatment.

In conclusion, the treatment of testosterone deficiency is a serious medical approach that is part of a comprehensive management of men’s health. Dr. Vardi supports his patients to ensure that the therapeutic benefit is real, while guaranteeing optimal safety during follow-up.

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