Context Although attention and concern about health disorders in aging men have been growing, the structure of psychological and somatic complaints of actual patients, not population-based cohorts, has not been elucidated in relation to sex hormone patterns and metabolism.

Objective Investigation of factors influencing complaint structures in aging male patients.

Design Cross-sectional cohort study.

Setting Andrological outpatient department.

Patients 434 consecutive male patients aged 50-86 yr.

Main outcome measures Hypotheses: a) psychosomatic complaints and metabolic factors in aging male patients are related to sex hormone levels in a symptom-specific manner, b) patients form sub-cohorts.

Results A clear-cut threshold for late-onset hypogonadism was not found; rather, prevalence of psychosomatic symptoms and metabolic risk factors accumulated with decreasing androgen levels. For example, androgen-induced prevalence of loss of libido or vigor increased below testosterone concentrations of 15 nmol/L (P < 0.001), while depression and diabetes mellitus type 2 (also in non-obese men) were significantly more present in men with testosterone concentrations <10 nmol/L (P < 0.001). Erectile dysfunction was identified as a composite pathology of metabolic risk factors, smoking and depressivity, while testosterone concentrations contributed to that symptom only <8 nmol/L (P = 0.003). Cluster analysis revealed aging men to present within three independent groups characterized by 1) psychosomatic complaints, 2) metabolic disorders and 3) sexual health problems. These sub-groups of patients exhibit distinct features in terms of androgen levels, age and body mass index.

Conclusions There is no evidence that a uniform structure of testosterone concentrations and complaints exists within the cohort of elderly male patients. Rather, in aging male patients, psychosomatic complaints and metabolic risk relate to testosterone in a symptom-specific manner.