Late-onset and functional hypogonadism in aging men: an integrated perspective on hormonal, sleep, and metabolic dimensions.

Plain-language summary

This review looked at how aging affects men's hormones, sleep, and metabolism, centering on two kinds of hypogonadism (when the testicles do not make enough testosterone, causing symptoms like low libido, fatigue, and weight gain). It distinguishes late-onset hypogonadism (the gradual, age-driven decline that is largely built into getting older) from functional hypogonadism (low testosterone driven by fixable causes like excess weight, poor sleep, and inactivity). Pulling together existing research, it found the decline is slow and often missed, and, importantly, that the functional kind can often be reversed by addressing its causes.

Key findings

• Progressive testosterone decline in aging men interacts bidirectionally with sleep disturbances and metabolic dysfunction.
• Sleep issues like insomnia and sleep apnea both result from and worsen hormonal and metabolic problems.
• Functional hypogonadism (low testosterone driven by lifestyle factors) may be reversible through weight loss, better sleep, and exercise, unlike classic LOH.
• Current diagnostic criteria for male hormonal aging remain controversial and often lead to underdiagnosis.