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Traditional signs and symptoms commonly attributed to hypogonadism do not correlate with testosterone levels: the Cooper Center Longitudinal Study Experience
  1. Laura F DeFina1,
  2. Nina B Radford2,
  3. David Leonard1,
  4. Rick K Wilson2,
  5. Tyler C Cooper2,
  6. S Michael Clark2,
  7. Gloria Lena Vega3,
  8. Carolyn E Barlow1,
  9. Benjamin L Willis1,
  10. Larry W Gibbons1,
  11. Ugis Gruntmanis3
  1. 1 Cooper Institute, Dallas, Texas, USA
  2. 2 Cooper Clinic, Dallas, Texas, USA
  3. 3 School of Health Professions, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
  1. Correspondence to Dr Laura F DeFina, The Cooper Institute, Dallas, TX 75230, USA; ldefina{at}


Evidence suggests that substantial testosterone therapy is occurring without checking levels of testosterone, presumably based on the presence of symptoms alone. We sought to explore the relationship between total testosterone level and non-specific symptoms, metabolic abnormalities, and sexual dysfunction associated with hypogonadism. This cross-sectional study included 2994 generally healthy men aged 50–79 years examined at a preventive medicine clinic in Dallas, TX from January 2012 to March 2016. Symptoms of hypogonadism were assessed. Screening morning total testosterone levels were measured and categorized into low (<250 ng/dL), low normal (250–399 ng/dL), and normal (≥400 ng/dL). Multiple logistic regression models were used to test the associations between total testosterone and signs and symptoms of hypogonadism. When considering symptoms and signs of hypogonadism, only decreased libido (OR 1.31, 95% CI 1.00 to 1.70), fasting glucose ≥100 mg/dL (OR 1.47, CI 1.15 to 1.88), and hemoglobin A1c over 6% (OR 1.47, 95% CI 1.06 to 2.03) were associated with increased odds of low testosterone after adjustment for age, body mass index, and cardiorespiratory fitness. Testosterone levels were not associated with fatigue, depression, or erectile dysfunction in our study (p>0.6). In this preventive medicine cohort, symptoms commonly attributed to testosterone deficiency were not associated with low total testosterone levels.

  • testosterone
  • symptoms
  • objective levels
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  • Contributors Conceived and designed the experiments: Defina, Radford, Leonard, Wilson, Cooper, Clark, Gibbons, and Gruntmanis. Performed the experiments: Defina, Leonard, Willis, Barlow, and Farrell. Analyzed and interpreted the data: Defina, Radford, Leonard, Wilson, Cooper, Clark, Willis, Vega, Barlow, Farrell, Gibbons, and Gruntmanis. Contributed reagents, materials, analysis tools or data: Wilson, Cooper, and Clark. Wrote the paper: Defina, Radford, Leonard, Wilson, Cooper, Clark, Willis, Vega, Barlow, Farrell, Gibbons, and Gruntmanis.

  • Funding The Cooper Institute, a 501(c)(3) non-profit research institute, provided internal funding for this study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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