European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis.

Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and va​gina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.

The andro-accelerator hypothesis.

Testosterone levels are known to decline with advancing age. However, there are frequent reports of inappropriate social behaviour involving middle-aged men, suggestive of hyperandrogenic state. The andro-accelerator hypothesis seeks to explain this phenomenon. This states that external stimuli, both asexual and sexual in nature, can increase or accelerate testosterone production, by stimulating the hypothalamo-pituitary-testicular axis, and resetting this axis at a higher level. This article discusses the concepts of andro-conditioning due to endocrine disruptor stimuli or endocrine disruptor social content, explores the clinical and public health relevance of the andro-accelerator hypothesis, and calls for a focus on addressing androgen imbalance, achieving "androequanimity", rather than treating andropause as a disease.

Concurrent training protocol for men with androgen deficiency in the aging male: a randomized clinical trial.

BACKGROUND: The androgen deficiency in the aging male (ADAM) affects physical, sexual, and psychological aspects with characteristics symptoms of middle-aged men. The practice of regular physical activity and physical exercise can attenuate these symptoms. The aim of this randomized clinical trial is to propose a physical exercise protocol based on concurrent training for middle-aged men with ADAM. METHOD: Randomized clinical trial with a 6-month intervention will randomly divided into two groups: experimental group (EG) and control group (CG). Four evaluations will be carried out, (1) pre-intervention; (2) in the first month of intervention; (3) in the third month of intervention; (4) post-intervention, evaluating: physical, psychological, sexual, and hormonal aspects. The intervention protocol with concurrent training will have duration of 6 months; frequency of 3 times weekly, with 60 min per session. The two-way ANOVA test will be used for the inter-group and intra-group comparisons with repeated measurements, and also Sydak's comparison test. CONCLUSION: This protocol was developed with the intent of easing the symptoms of ADAM. In addition, it is believed that the concurrent training protocol could be capable to recover hormonal, physical, psychological, and sexual aspect of middle-aged men with ADAM.

Awareness and experience of andropause symptoms in men referring to health centers: a cross-sectional study in Iran.

INTRODUCTION: Andropause is a gradual process and more similar to menopause in women. Knowledge and experience of symptoms of andropause is an important discussion is in their lives. OBJECTIVES: This study aimed to determine Awareness and Experience of Andropause Symptoms in Men referring to Health Centers in Rasht, Iran. MATERIALS AND METHODS: This cross-sectional and analytical study included 140 men over 40 years referring to one of health centers. Collection tool of this study was a questionnaire consisting of three parts. The first part was about demographic characteristics, The second part was a researcher-made questionnaire, The third part was Aging Male Scales (AMS) questionnaire. Data were analyzed by descriptive and analytical statistics. RESULTS: This study showed 73.6% had experience symptoms of andropause. The mean knowledge score (of 20 score) for the 3/3 ± 4/9, with the level of education, occupation and income was statistically significant (p < 0.05). There was significant relationship the andropause symptoms with BMI and occupation (p < 0.05). CONCLUSION: Based on the results of this study, despite the fact that the majority of men over age 40 had experienced symptoms of andropause, but their awareness about andropause was very low.

Modification Effects of Changes in Job Demands on Associations Between Changes in Testosterone Levels and Andropause Symptoms: 2-Year Follow-up Study in Male Middle-Aged Japanese Workers.

PURPOSE: The purpose of this longitudinal study was to ascertain if changes in job demands modify associations between changes in testosterone levels and andropause symptoms in male Japanese workers. METHOD: A baseline survey including job demands and the Aging Males' Symptoms scale, lifestyle factors, and blood levels of testosterone was conducted in 2007. Among 192 men (mean age ± SD 52.2 ± 7.6 years) who completed all relevant questionnaires and provided blood at baseline, 104 men (50.9 ± 7.2 years) were followed up in 2009. Changes of variables in 2 years were calculated (data of follow-up minus those of baseline). RESULTS: Testosterone levels were increased significantly, whereas job demands and somatic symptoms were reduced significantly, at follow-up. Changes in testosterone levels were negatively associated with changes in total andropause symptoms, psychological symptoms, and sexual symptoms (standardized ß = -0.27, -0.24, and, -0.29, p < 0.05, respectively), after adjustment for confounders. Changes in job demands were positively associated with changes in somatic symptoms (standardized ß = 0.21, p < 0.05). Significant interactions of changes in testosterone levels and job demands were noted for changes in psychological symptoms (standardized ß = 0.26, p < 0.05). For men with a 1-SD reduction in job demands, negative associations between changes in testosterone levels and psychological symptoms were intensified, but not for men with a 1-SD increase in job demands. CONCLUSION: Andropause symptoms may be affected by changes in testosterone levels and job demands. Change in job demands may modify associations between changes in testosterone levels and andropause symptoms.

[Gender Features of Radical Oxidation of Lipids in Menopausal Women and Men in Andropause].

Aims: Our aim was to assess lipid peroxidation ­ antioxidant protection in menopausal women and men in andropause and to compare these processes in different gender and age groups. Materials and Methods: 74 women and 37 men were examined. This study was a prospective, randomized cohort study. Women were divided into perimenopausal group (n=22, mean age 49.03±3.13), postmenopausal group (n=15, mean age 54.43±4.54) and control (n=37, mean age 34±1.2). Men were divided into a group of andropause (n=20, mean age 50.38±2.63) and control (n=17, mean age 35.21±4.75). Body mass index in the main and control groups was comparable. Questionnaires, clinical examination, assessment of the lipid peroxidation-antioxidant defense system, and the calculation of oxidative stress ratio were conducted to all participants of the study. Results: In women from the reproductive phase transition to its extinction increases content of compounds with conjugated double bonds by 22% (p<0.05) in perimenopause and by 27% (p<0.05) in postmenopause, increases content of the ketodienes and coupled trienes by 21% (p<0.05) in perimenopause relative to the control group and reduced by 27% (p<0.05) in postmenopausal women relative to the group of perimenopause. The antioxidant system in women observed the following changes: decrease in the α-tocopherol levels in postmenopausal women by 37% relative to control and by 22% (p<0.05) to compare perimenopause; reduction of retinol level by 29% (p<0.05) in the perimenopause and by 39% (p<0.05) in postmenopause relative to control, increasing of the content of GSSG by 18% (p<0.05) in postmenopause to compare control. When comparing groups of men statistically significant differences were not found. When comparing the groups according to gender, we revealed in men the increased content of compounds with conjugated double bonds by 38% (p<0.05), the GSSG by 13% (p<0.05), reduced content of the ketodienes and coupled trienes by 43% (p<0,05), α-tocopherol by 24% (p<0.05), SOD activity by 9% (p<0.05).Coefficient oxidative stress in perimenopausal women was 2,5, in postmenopausal ­ 3,48, in andropause ­ 0,97. Conclusions: Expressed lipid peroxidation activity is more physiological in andropause than in menopause. Men in andropause have large functional reserves and adaptive capacity than menopausal women.

The endocrine dyscrasia that accompanies menopause and andropause induces aberrant cell cycle signaling that triggers re-entry of post-mitotic neurons into the cell cycle, neurodysfunction, neurodegeneration and cognitive disease.

This article is part of a Special Issue "SBN 2014". Sex hormones are physiological factors that promote neurogenesis during embryonic and fetal development. During childhood and adulthood these hormones support the maintenance of brain structure and function via neurogenesis and the formation of dendritic spines, axons and synapses required for the capture, processing and retrieval of information (memories). Not surprisingly, changes in these reproductive hormones that occur with menopause and during andropause are strongly correlated with neurodegeneration and cognitive decline. In this connection, much evidence now indicates that Alzheimer's disease (AD) involves aberrant re-entry of post-mitotic neurons into the cell cycle. Cell cycle abnormalities appear very early in the disease, prior to the appearance of plaques and tangles, and explain the biochemical, neuropathological and cognitive changes observed with disease progression. Intriguingly, a recent animal study has demonstrated that induction of adult neurogenesis results in the loss of previously encoded memories while decreasing neurogenesis after memory formation during infancy mitigated forgetting. Here we review the biochemical, epidemiological and clinical evidence that alterations in sex hormone signaling associated with menopause and andropause drive the aberrant re-entry of post-mitotic neurons into an abortive cell cycle that leads to neurite retraction, neuron dysfunction and neuron death. When the reproductive axis is in balance, gonadotropins such as luteinizing hormone (LH), and its fetal homolog, human chorionic gonadotropin (hCG), promote pluripotent human and totipotent murine embryonic stem cell and neuron proliferation. However, strong evidence supports menopausal/andropausal elevations in the LH:sex steroid ratio as driving aberrant mitotic events. These include the upregulation of tumor necrosis factor; amyloid-ß precursor protein processing towards the production of mitogenic Aß; and the activation of Cdk5, a key regulator of cell cycle progression and tau phosphorylation (a cardinal feature of both neurogenesis and neurodegeneration). Cognitive and biochemical studies confirm the negative consequences of a high LH:sex steroid ratio on dendritic spine density and human cognitive performance. Prospective epidemiological and clinical evidence in humans supports the premise that rebalancing the ratio of circulating gonadotropins:sex steroids reduces the incidence of AD. Together, these data support endocrine dyscrasia and the subsequent loss of cell cycle control as an important etiological event in the development of neurodegenerative diseases including AD, stroke and Parkinson's disease.

Are andropause symptoms related to depression?

BACKGROUND: Andropause is a middle-age condition in which men experience changes in their physical, spiritual and emotional health. The association between andropause and psychological symptoms such as depression are not very clear yet. AIMS: The objective of this study was therefore to determine the association between the 'Aging Males Symptoms Scale' (AMS) and depression. METHODS: A cross sectional study was conducted among 521 old men. To collect data, the AMS and the Patient Health Questionnaires 2 and 9 were used to screen depression, in addition to questions on background and fertility. Multiple linear regression analysis was used to assess the association between andropause symptoms and depression. RESULTS: Based on our results and the AMS score, 51.5% of the study population had clinical symptoms of androgen disorder, 3.7% of which had severe symptoms. There was a strong correlation between the AMS score and depression. Depression, diabetes, cigarette smoking and spousal age retained their significant associations even after entering the relevant demographic, anthropometric, smoking and disease variables in the multivariable model. As a positive predictive factor, depression had the strongest association with AMS. CONCLUSIONS: Based on our results, there is a direct association between andropause symptoms and depression, where the increasing AMS score corresponds with the severity of depression. DISCUSSION: Our results show the need of screening for depression when evaluating andropause symptoms.

Gender, sex steroid hormones, and Alzheimer's disease.

Age-related loss of sex steroid hormones is a established risk factor for the development of Alzheimer's disease (AD) in women and men. While the relationships between the sex steroid hormones and AD are not fully understood, findings from both human and experimental paradigms indicate that depletion of estrogens in women and androgens in men increases vulnerability of the aging brain to AD pathogenesis. We review evidence of a wide range of beneficial neural actions of sex steroid hormones that may contribute to their hypothesized protective roles against AD. Both estrogens and androgens exert general neuroprotective actions relevant to a several neurodegenerative conditions, some in a sex-specific manner, including protection from neuron death and promotion of select aspects of neural plasticity. In addition, estrogens and androgens regulate key processes implicated in AD pathogenesis, in particular the accumulation of ß-amyloid protein. We discuss evidence of hormone-specific mechanisms related to the regulation of the production and clearance of ß-amyloid as critical protective pathways. Continued elucidation of these pathways promises to yield effective hormone-based strategies to delay development of AD.

Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels.

IMPORTANCE: Rates of testosterone therapy are increasing and the effects of testosterone therapy on cardiovascular outcomes and mortality are unknown. A recent randomized clinical trial of testosterone therapy in men with a high prevalence of cardiovascular diseases was stopped prematurely due to adverse cardiovascular events raising concerns about testosterone therapy safety. OBJECTIVES: To assess the association between testosterone therapy and all-cause mortality, myocardial infarction (MI), or stroke among male veterans and to determine whether this association is modified by underlying coronary artery disease. DESIGN, SETTING, AND PATIENTS: A retrospective national cohort study of men with low testosterone levels (<300 ng/dL) who underwent coronary angiography in the Veterans Affairs (VA) system between 2005 and 2011. MAIN OUTCOMES AND MEASURES: Primary outcome was a composite of all-cause mortality, MI, and ischemic stroke. RESULTS: Of the 8709 men with a total testosterone level lower than 300 ng/dL, 1223 patients started testosterone therapy after a median of 531 days following coronary angiography. Of the 1710 outcome events, 748 men died, 443 had MIs, and 519 had strokes. Of 7486 patients not receiving testosterone therapy, 681 died, 420 had MIs, and 486 had strokes. Among 1223 patients receiving testosterone therapy, 67 died, 23 had MIs, and 33 had strokes. At 3 years after coronary angiography, the Kaplan-Meier estimated cumulative percentages with events were 19.9%in the no testosterone therapy group vs 25.7%in the testosterone therapy group,with an absolute risk difference of 5.8%(95%CI, -1.4%to 13.1%) [corrected].The Kaplan-Meier estimated cumulative percentages with events among the no testosterone therapy group vs testosterone therapy group at 1 year after coronary angiography were 10.1% vs 11.3%; at 2 years, 15.4% vs 18.5%; and at 3 years, 19.9% vs 25.7 [corrected].There was no significant difference in the effect size of testosterone therapy among those with and without coronary artery disease (test for interaction, P = .41). CONCLUSIONS AND RELEVANCE: Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. These findings may inform the discussion about the potential risks of testosterone therapy.

[Clinical study of 62 patients with symptoms of male climacterium].

We prospectively reviewed the records of 62 patients who had sought evaluation at our hospital with a chief complaint of male climacteric symptoms. Late-onset hypogonadism (LOH)-related symptoms were evaluated during the initial visit based on the Aging Males' Symptoms (AMS) score, International Index of Erectile Function (IIEF) -5 score, and Center for Epidemiologic Studies Depression Scale (CES-D). Laboratory and endocrinologic testing, including the free testosterone (FT) level, was performed with blood samples collected before 10 : 00 am. The AMS psychological and CES-D scores in patients with a FT ＞8.5 pg/ml were significantly higher than those in patients with a FT ≦8.5 pg/ml. The study included 32 patients who were diagnosed with LOH (FT ≦8.5 pg/ml) and treated with androgen replacement therapy (ART). The total, somatic, psychological, and sexual scores of the AMS were significantly decreased after the third intramuscular administration of testosterone enanthate; there were no serious complications. Because a significant proportion of depressed patients may be amongst the patients with aging male's symptoms, it is important to consider depression in the exclusion diagnosis during a clinical examination for LOH.

Andropausal symptoms in men with Type 2 diabetes.

AIMS: Serum androgen concentration is reported to be low in patients with Type 2 diabetes. There have been no studies comparing andropausal symptoms such as sleep disturbance, depression, erectile dysfunction and lower urinary tract symptoms simultaneously between men with Type 2 diabetes and subjects without diabetes. METHODS: We compared andropausal symptom scores such as the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, the International Index of Erectile Function and the International Prostate Symptom Score in 296 men with Type 2 diabetes and in 267 subjects without diabetes. Furthermore, we evaluated relationships of andropausal symptom scores to various anthropometric factors and compared andropausal symptom scores according to diabetic complications in men with Type 2 diabetes. RESULTS: Andropausal symptom scores such as the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, the International Index of Erectile Function and the International Prostate Symptom Score were 4.2 ± 2.6 vs. 5.0 ± 3.3, P<0.01 by unpaired Student's t-test, 34.8 ± 8.2 vs. 38.4 ± 9.3, P<0.0001, 11.5 ± 6.4 vs. 9.9 ± 6.9, P<0.01 and 7.3 ± 6.7 vs. 9.0 ± 7.1, P<0.01 in subjects without diabetes and in patients with diabetes, respectively. The Pittsburgh Sleep Quality Index was higher in patients with neuropathy than without. The Self-Rating Depression Scale was higher in patients with advanced retinopathy. The International Index of Erectile Function was lower in patients with advanced retinopathy and nephropathy. The International Index of Erectile Function was lower and the International Prostate Symptom Score was higher in patients with cardiovascular disease than without. CONCLUSIONS: Our data demonstrated that men with Type 2 diabetes have higher prevalence of andropausal symptoms, especially those with diabetic complications.

The impact of androgen receptor CAG repeat polymorphism on andropausal symptoms in different serum testosterone levels.

INTRODUCTION: In addition to a depletion of androgen, attenuated action of androgen receptor (AR) might also contribute to andropausal symptoms. AIM: To evaluate the interaction of AR cytosine adenine guanine (CAG) repeat polymorphism and serum testosterone levels and their effect on andropausal symptoms in aging Taiwanese men. METHODS: From August 2007 to April 2008, a free health screening for men older than 40 years was conducted by a medical center in Kaohsiung City, Taiwan. All participants received physical examination, answered questionnaires to collect their demographic information and medical histories, completed the Androgen Deficiency in the Aging Male (ADAM) questionnaire, and provided 20-cm(3) whole blood samples for biochemical and genetic evaluation. MAIN OUTCOME MEASURES: The ADAM questionnaire was used to evaluate andropausal symptoms. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. RESULTS: Seven hundred two men with the mean age of 57.2 ± 6.5 years were included. There was no significant association between TT levels and the distribution of AR CAG repeat polymorphism. When TT levels were above 340 ng/dL, subjects with AR CAG repeat lengths ~25 showed significantly higher risk of developing andropausal symptoms, as compared with those with AR CAG repeat lengths ~22 (P = 0.006), but this was not observed when TT levels were 340 ng/dL or below. Age and number of comorbidities were also independent risk factors for andropausal symptoms. CONCLUSION: In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing andropausal symptoms. Age and number of comorbidities can also influence the appearance of andropausal symptoms. In clinical practice, a multifactorial approach to evaluate andropausal symptoms and the interactions between those risk factors is suggested.

[Pathogenesis and clinical presentation of andropause]. / Patogeneza i obraz kliniczny andropauzy.

In opposition to women, the age-related changes in reproductive hormones in men are subtle and occur gradually throughout many years of mature life. The decline in serum testosterone level may present as a constellation of signs and symptoms of hypogonadism known as "andropause". They include: loss of energy, depressed mood, decreased libido, erectile dysfunction, decreased muscle mass and strength, increased fat mass, frailty, osteopenia, and osteoporosis. Diagnosis of andropause is based on clinical symptoms and laboratory determinations of serum testosterone levels. This review summarises the present state of knowledge on the pathogenesis, clinical presentation as well as diagnosis of andropause.

[Treatment of patients with andropause]. / Leczenie chorych w okresie andropauzy.

The decline in serum testosterone level occur gradually throughout men's mature life and it may present as a constellation of signs and symptoms of hypogonadism known as "andropause". When diagnosed, the treatment should be introduced. The benefits of testosterone supplementation in this age group have yet to be equivocally established. Although testosterone therapy can induce adverse effects, these can be largely minimised by proper monitoring. This review summarises the present state of knowledge on the treatment of andropause.

[Andropause and testosterone deficiency: how to treat in 2012?]. / Andropause et carence en testostérone: le point en 2012.

Age-related hypogonadism is a clinical syndrome defined as a low serum testosterone level (< 11 nmol/l) with precise clinical symptoms: diminished libido, erectile dysfunction, and loss of morning erection. Testosterone supplementation has been shown to have a beneficial effect on muscle and fat mass as well as on bone mineral density, with more conflicting effects observed on muscle strength, sexual function, mood and quality of life. In spite of an inverse relationship between testosterone levels and various cardiovascular risk factors (obesity, insulin resistance and type 2 diabetes mellitus), there is no evidence of a positive effect of testosterone replacement therapy towards these risk factors. So far, the long-term safety of testosterone replacement therapy has not been established. Evidence has been found that testosterone replacement therapy has a causative and worsening role in prostate cancer urging not to treat patients with a history of prostate cancer. Finally, patients with high cardiovascular risk, including those with congestive heart failure, should not be treated.

Effect of Tetragonia tetragonoides (Pall.) Kuntze Extract on Andropause Symptoms.

Testosterone and free testosterone levels decrease in men as they age, consequently inducing andropause symptoms, such as weight gain, fatigue, and depression. Therefore, this study aimed to evaluate the reducing effect of New Zealand spinach (NZS) on these androgenic symptoms by orally administering its extract to 26-week-old rats for four weeks. Biochemical blood testing was conducted, and the andropause symptoms-related indicators and muscular endurance levels were examined. In the NZS extract-treated rats, the decrease in muscle mass was suppressed, and immobility time was reduced in the forced swim test. In addition, the grip force and muscular endurance of the forelimbs were significantly increased compared to the control group; therefore, NZS extract exhibits a positive effect on the maintenance of muscle mass and improves muscular endurance. The representative male hormones, testosterone and progesterone, in the NZS extract-treated group were 1.84 times and 2.48 times higher than those in the control groups, respectively. Moreover, cholesterol and low-density lipoprotein, which affect lipid metabolism, were significantly reduced in the NZS extract-treated group. Overall, NZS extract shows potential for further development as a functional food material for improving muscle strength and relieving andropause symptoms.

Current Management and Controversies Surrounding Andropause.

Andropause is a condition surrounded by controversies, whether it be through its diagnosis or management. As we learn more about the pathophysiology of hypogonadism, our perspectives on the risks and benefits of testosterone therapy have shifted. We attempt to discuss the most modern and relevant points of controversy currently affecting the field. Throughout this review, we discuss the art of diagnosing hypogonadism as well as the association or lack thereof between testosterone replacement therapy and cardiovascular disease, prostate cancer, thrombosis, antiaging effects, exogenous steroid abuse, and diabetes mellitus.

Male menopause: is it a real clinical syndrome?

The association between aging-related testosterone deficiency and late-onset clinical hypogonadism in men remains a controversial concept. Several descriptive names, such as andropause, male menopause, partial androgen deficiency of the aging male and late-onset hypogonadism, have been suggested in an attempt to connect the age-related decline in androgen production and symptoms of aging in men. However, despite many studies, no clear correlation has been established and, as a result, there is also a debate over the use of androgen replacement therapy in this clinical set-up. Nevertheless, new data from large-scale studies have been recently published, which shed more light on this complicated issue. A recent New England Journal of Medicine article demonstrated that only a minor fraction (2%) of elderly men suffer from this clinical syndrome and gave serum testosterone level thresholds that support it.

Self-referred older Asian males in a men's health clinic: the inter-relationships between androgens, metabolic parameters and quality of life measures.

BACKGROUND: Current data on late-onset hypogonadism, derived from healthy males in epidemiological studies, may not reflect the profile of men seen in actual clinical practice. OBJECTIVE: To examine androgen levels in relation to metabolic status and quality of life (QOL) measures in self-referred men at a hospital-based Men's Health clinic. METHODS: Cross-sectional study of 238 consecutive Asian males. Fasting total testosterone (TT), sex-hormone binding globulin (SHBG), luteinising (LH) and follicle stimulating (FSH) hormones, glucose (FPG) and lipid profile were measured. Bioavailable (cBT) and free testosterone (cFT) were calculated. Waist circumference (WC) and body mass index (BMI) were collected. Subjects also answered the modified International Index of Erectile Dysfunction (IIEF-5) and Ageing Male Symptom (AMS) questionnaires. RESULTS: Among non-diabetic males (N = 201), no change was noted for TT, although SHBG and gonadotrophins rose, while cBT and cFT declined, significantly with age. Sex hormones were negatively related with WC, BMI and FPG. SHBG displayed a stronger association with metabolic components than testosterone. Testosterone was not related to lipids, IIEF-5 or AMS scores. WC, not BMI, was a key determinant of TT, cBT and cFT in younger subjects, while FSH seemed a more sensitive indicator of primary hypogonadism than LH in older males. CONCLUSION: The preferred measures of serum testosterone in older men are cBT and cFT. Visceral adiposity and SHBG, rather than testosterone, appeared to be the link between androgen deficiency and poorer metabolic status. QOL scores correlate poorly with androgen concentrations.