Late Onset Hypogonadism (LOH)
Have you been experiencing extremely tired, unmotivated, lacking sexual desire, or unable to sleep lately? These could be symptoms of LOH (Late-Onset Hypogonadism) syndrome.
Despite the growing global attention to LOH syndrome, the availability of treatment in Japan has been limited due to lack of recognition.
We are highly specialized in diagnosing and treating LOH syndrome: you can consult with certified testosterone treatment specialists to discuss appropriate hormone therapy and future plans, ensuring you receive the best possible care.
Consultations for LOH are not covered by Japanese National Health Insurance.
If you have any questions about LOH, please contact us via our official LINE account.
Please select the section to jump.
Note that the prices indicated in this page are all inclusive of tax.
About LOH
It is estimated that approximately 6 million people in Japan suffer from LOH, a condition that has been recognized globally since the early 2000s (it is sometimes referred to as LOH syndrome).
LOH is defined as “a syndrome caused by a decrease in male hormones (testosterone) associated with aging and stress.” In recent years, cases of decreased male hormone levels have been observed even in younger men (in their 20s and 30s).
Male hormones play various roles beyond just sperm production and muscle strengthening. They also affect muscles, bones, the central nervous system, the prostate, sexual function, and urinary function. When men experience LOH, these functions can be impaired, leading to a variety of symptoms as listed below.
– Decreased sexual desire (★)
– Weaker erections (★)
– Feeling less energetic
– Reduced physical strength or stamina
– Shorter height
– Feeling less enjoyment in daily life
– Feeling sad or irritable
– Reduced exercise capacity
– Falling asleep after dinner
– Decreased work performance
If you experience both (★) symptoms or more than three of the symptoms listed above, you may have LOH.
While male hormones are often associated with “sexual desire,” they also have a significant impact on mental well-being. We frequently hear about symptoms such as “having sexual desire but being unable to sleep well” or “being told that your personality has changed and feeling an inexplicable sense of anxiety.”
To objectively assess the severity of LOH symptoms, the AMS score (Aging Males’ Symptoms questionnaire) can be used. This questionnaire allows you to evaluate your condition on a scale from 1 (no symptoms) to 5 (very severe symptoms) across various categories. By totaling your score, you can better understand the severity of your symptoms.
The AMS score is also known to be highly useful in measuring the effectiveness of hormone therapy.
[AMS Score]
For each question, rate the severity of your symptoms on a scale from 1 to 5. The total score across 17 items will help gauge the overall severity of your symptoms.
Symptom | None | Mild | Moderate | Severe | Very Severe |
---|---|---|---|---|---|
Feeling unwell both physically and mentally | 1 | 2 | 3 | 4 | 5 |
Joint or muscle pain (e.g., back pain, joint pain) | 1 | 2 | 3 | 4 | 5 |
Sweating or hot flashes | 1 | 2 | 3 | 4 | 5 |
Difficulty sleeping or shallow sleep | 1 | 2 | 3 | 4 | 5 |
Frequently feeling tired Often feeling fatigued | 1 | 2 | 3 | 4 | 5 |
Feeling irritable or moody | 1 | 2 | 3 | 4 | 5 |
Feeling more nervous | 1 | 2 | 3 | 4 | 5 |
Feeling more anxious | 1 | 2 | 3 | 4 | 5 |
Lack of motivation or energy Persistent fatigue | 1 | 2 | 3 | 4 | 5 |
Feeling weaker | 1 | 2 | 3 | 4 | 5 |
Feeling depressed or powerless | 1 | 2 | 3 | 4 | 5 |
Feeling like your best days are behind you | 1 | 2 | 3 | 4 | 5 |
Feeling burnt out Feeling at rock bottom | 1 | 2 | 3 | 4 | 5 |
Slower beard growth | 1 | 2 | 3 | 4 | 5 |
Feeling a decline in sexual ability | 1 | 2 | 3 | 4 | 5 |
Fewer morning erections | 1 | 2 | 3 | 4 | 5 |
Feeling a decrease in sexual desire | 1 | 2 | 3 | 4 | 5 |
Source: Japan Urological Association / Japan Men’s Health Medicine Association “LOH Syndrome Clinical Guidelines,” and the Working Committee’s “Guidelines for Clinical Practice of Late-Onset Hypogonadism.”
17-26 points: No issues
27-36 points: Mild
37-49 points: Moderate
50 points or more: Severe
If your score falls in the mild range or higher and you are experiencing concerning symptoms, please feel free to visit us for consultation.
Unlike female menopause, LOH does not have a defined onset period. Once male hormone levels decline, symptoms can persist for the rest of your life.
Therefore, if you are experiencing any symptoms that concern you, we recommend undergoing a thorough examination.
Category | Men | Women |
---|---|---|
Cause | Decrease in male hormones | Decrease in female hormones |
Onset Period | No specific period (can occur anytime after age 40) | 5 years before and after menopause (around age 50) |
Duration | Indefinite | Symptoms generally subside within 5 years after menopause |
Diagnosis and Treatment Process
Our LOH Clinic offers treatment tailored to each patient’s condition through the following three steps:
Counseling and Testing
If you suspect you have symptoms of LOH or wish to be tested, you can undergo a detailed examination following a consultation with one of our doctors.
During the LOH testing, STI screening is also available at a special rate.
We also offer consultations for those who are already undergoing treatment but are concerned about their future treatment options.
Diagnosis and Treatment
Based on the test results, we will diagnose LOH. According to current guidelines, treatment eligibility is determined not only by blood test values but also by considering the severity of the patient’s symptoms.
In the past, short-acting testosterone preparations were commonly used to treat LOH. However, due to the extremely unstable supply of short-acting testosterone preparations and the significant fluctuations in hormone levels after administration, which often lead to side effects, this approach has posed challenges.
We offer long-acting testosterone medication (Nebido generic), which allows for safe, affordable, and less burdensome treatment.
It is very dangerous to undergo hormone therapy without proper medical guidance. Always ensure that treatment is conducted under the supervision of a doctor.
Regular Tests and ED Treatment Associated with Hormone Therapy
After starting hormone replacement therapy, we regularly check testosterone levels and monitor changes in symptoms to ensure that treatment continues safely.
ED medications are also considered effective in treating LOH, as they can help improve erectile dysfunction and sexual function and may also contribute to increasing testosterone levels.
We offer consultations and treatment for ED for those who are interested.
Testing for LOH
Diagnosis of LOH involves checking whether the levels of “free testosterone” and “testosterone” meet the standard values and whether other conditions, particularly lifestyle diseases, might be contributing to the decline in male hormones.
We offer a comprehensive range of tests necessary for diagnosing LOH, starting at 10,000 JPY for the initial visit.
Additionally, PSA testing, a tumor marker for prostate cancer, is recommended when undergoing hormone therapy. This is because beginning male hormone therapy in individuals who already have prostate cancer can accelerate the progression of the disease. (There is no evidence that male hormones cause prostate cancer, but it is dangerous for those who already have it to start hormone therapy.)
We recommend PSA testing for individuals concerned about prostate cancer or those of an appropriate age. The additional cost is only 2,000 JPY.
We also offer STI screening at a special price of 10,000 JPY (otherwise 24,000 JPY) during the LOH testing, so please take advantage of this opportunity.
LOH is closely related to lifestyle diseases such as diabetes. If any abnormalities are found in the blood test set, we can begin treatment simultaneously.
At our clinic, a certified testosterone treatment doctor will recommend the most appropriate tests and treatments based on your symptoms.
Test Components: Complete blood count, liver function, kidney function, electrolytes, uric acid, CK, TG, LDL, HDL, blood glucose, HbA1c, zinc, magnesium, vitamin D, thyroid function tests, testosterone, free testosterone (10,000 JPY)
Optional: PSA (2,000 JPY, incl. tax)
STI Screening (Optional): HIV, Hepatitis B, Syphilis, Gonorrhea, Chlamydia (testing of genital, throat, and anal areas) (10,000 JPY, incl. tax) [Usually 24,000 JPY]
Lifestyle Improvements
Lifestyle improvements include changes in diet, exercise habits, workplace environment, and personal relationships. However, some of these may be difficult to improve immediately.
Many individuals with LOH feel a decline in physical strength or lack the motivation to make lifestyle changes (which is itself a symptom of the syndrome). In such cases, considering the initiation of testosterone therapy may be beneficial.
Testosterone Therapy
There are three methods of testosterone supplementation: injections, oral medications, and topical applications. Our clinic offers all of these options.
Available Options:
Injections: Short-acting testosterone (Enarmon Depot 125mg, 250mg), Long-acting testosterone (Nebido generic)
Topical Applications: Glomin, 1UP Formula
Oral Medications: Long-acting testosterone (Nebido generic capsule)
Among these, we particularly recommend the oral medication Nebido generic capsule.
The Nebido generic oral medication allows for effective and safe testosterone supplementation with just one tablet per day. It is convenient, affordable, and easy to continue.
Additionally, the dosage can be gradually adjusted according to the patient’s symptoms, allowing for a smooth and manageable treatment process by monitoring hormone levels and making necessary adjustments.
Nebido is a medication manufactured by Schering AG in Germany. It is used in hormone replacement therapy for treating conditions such as LOH and gender dysphoria (GD) caused by testosterone deficiency.
Although Nebido is not approved in Japan, it is already authorized and used in Europe and the United States, where it is regarded as a safe medication.
The Nebido generic oral medication (testosterone undecanoate) is approved by the U.S. Food and Drug Administration (FDA). According to scientific reports, it is effective in improving and maintaining testosterone levels without a significant increase in the risk of severe side effects (see the original FDA page here, and the relevant scientific report here).
1 Box: 5,000 JPY/30 tablets
3 Boxes: 14,000 JPY/90 tablets
6 Boxes: 27,000 JPY/180 tablets
– The standard initial dose is one tablet per day. The dosage can be adjusted based on symptoms.
Testosterone therapy is a generally safe treatment, but some side effects have been reported.
At our clinic, we not only monitor for these side effects, but we also optimize hormone dosage based on hormone levels to minimize the risk of side effects and provide the safest possible treatment.
Side Effects of Hormone Therapy
– Liver dysfunction
– Polycythemia
– Increased body hair and acne
– Decreased testicular function, among others
At our clinic, we perform regular blood tests every three months (3,000 JPY, incl. tax) to evaluate the effectiveness of hormone therapy and to adjust the treatment based on hormone levels.
For those who wish, we can also conduct tests for lifestyle-related diseases during these check-ups.
Hormone Level Measurement: Testosterone, Free Testosterone (3,000 JPY, incl. tax)
Lifestyle Disease Screening (Optional): Complete blood count, liver function, kidney function, electrolytes, uric acid, CK, TG, LDL, HDL, blood glucose, HbA1c (3,000 JPY, incl. tax)
ED Medications
ED medications have been shown to be highly effective for men with LOH who experience erectile dysfunction.
Recent research has also shown that taking ED medications can not only improve ED but also increase blood testosterone levels, making them suitable even for men with LOH who do not have erectile dysfunction.
We have been offering a variety of ED medications tailored to our patients’ needs, so please feel free to consult with us.
Costs and Pricing
The fees for non-insurance treatments are calculated based on the following pricing system.
The LOH (LOH) Clinic operates primarily on a non-insurance basis.
[Price] = [Consultation Fee] + [Test Fees] + [Medication Fees]
Consultation Fees
Consultation fees vary depending on whether it is your first visit or a follow-up.
If you have visited our clinic before, regardless of whether it was for insurance or non-insurance treatment, follow-up fees will apply.
First Visit: 2,500 JPY
Follow-up: 1,000 JPY
Test Fees
The test fees are as follows:
[At Initial Consultation]
Test Type | Fee (JPY) | Test Results* |
---|---|---|
Initial Blood Test Package (Including Hormone Test) |
10,000 | In 2-3 days |
Initial STI Test Package (Optional) |
10,000 ( |
In 4-5 days |
Hormone Test [Testosterone + Free Testosterone] (Optional) |
3,000 | In 4-5 days |
PSA Test (Optional) |
2,000 | In 2-3 days |
Test Fees
The test fees are as follows:
Type of Test | Price (JPY) | Test Results* |
---|---|---|
Initial Hormone Therapy Blood Test Package (including hormone tests) |
10,000 | 2-3 days later |
Initial STI Test Package |
10,000 |
4-5 days later |
Follow-up Blood Test Package (for 2nd+ visits) |
3,000 | 2-3 days later |
Testosterone + Free Testosterone |
3,000 | 4-5 days later |
PSA Test | 2,000 | 2-3 days later |
D-dimer (Evaluation of Thrombosis Risk) |
1,500 | 2-3 days later |
* The calculation of result-reporting day begins when the collected samples arrive at the laboratory. If samples are collected in the evening, on weekends or on national holidays, the countdown begins from the next business day of the laboratory.
Treatment Prices
The prices for hormone therapy are as follows:
Our clinic offers various treatment options, including long-acting oral and topical testosterone preparations.
Type | Preparation | Prices (JPY) |
---|---|---|
Long-acting Testosterone(Oral) |
Nebido Generic Oral(Cernos capsule) | 5,000/30 tablets 14,000/90 tablets 27,000/180 tablets |
Nebido Generic Injection(Cernos injection) | 18,000* | |
Testosterone Cream | Glomin (1% testosterone topical gel) |
4,100 |
1UP Formula (5% testosterone topical gel) |
2,200 (+ medication cost)** |
|
Short-acting Testosterone |
Enarmon Depot 125mg Testin Depot 125mg |
2,500 |
Enarmon Depot 250mg | 3,500 |
* The cost includes hormone level testing.
** For 1UP Formula, the self-pay prescription fee of 2,200 JPY is paid at our clinic, and the medication cost is paid separately at a specialized pharmacy (approximately 12,100 JPY).
We also offer prescriptions for ED medications. The prices are as follows:
Medication Name | Dosage | Price (JPY) |
---|---|---|
(Brand) Viagra(Generic) Sildenafil | Viagra 50mg | 1,600 (1 tablet) 14,000 (10 tablets) |
Viagra OD Film 50mg | 1,200 (1 tablet) 11,000 (10 tablets) |
|
Sildenafil 50mg | 1,000 (1 tablet) 9,000 (10 tablets) |
|
(Brand) Levitra(Generic) Vardenafil | *We do not carry Levitra | — |
Vardenafil 10mg | 1,500 (1 tablet) 13,000 (10 tablets) |
|
Vardenafil 20mg | 1,700 (1 tablet) 15,000 (10 tablets) |
|
(Brand) Cialis(Generic) Tadalafil | Cialis 10mg | 1,800 (1 tablet) 14,000 (10 tablets) |
Cialis 20mg | 2,000 (1 tablet) 18,000 (10 tablets) |
|
Tadalafil 10mg | 1,400(1 tablet) 12,000 (10 tablets) |
|
Tadalafil 20mg | 1,600(1 tablet) 14,000 (10 tablets) |
|
Trial Package | Tadalafil 10mg + Vardenafil 10mg + Sildenafil 50mg | 3,400 JPY |
Types and Flow of Consultation
Consultations for LOH (male menopause) are prioritized by appointment at our clinic.
Walk-ins may experience longer wait times, so we encourage you to make an appointment and fill out the questionnaire in advance.
Make an Appointment
Please make an appointment through the “In-Person Consultation” section on our official website.
Fill Out the Questionnaire
After completing your appointment, click the link provided in the official LINE or appointment confirmation email to fill out the questionnaire.
Visit on the Appointment Day
Please visit our clinic at your appointment time. You will be given a number at reception, and we will call you by this number for tests, payments, and other services.
Doctor Consultation and Examination
Based on your questionnaire, we will provide appropriate advice, tests, and treatment as needed.
Dr. Daisuke SHIOJIRI
Director of Personal Health Clinic, Doctor of Medicine. Providing medically accurate knowledge and compassionate care at National Center for Global Health and Medicine (Shinjuku, Tokyo) and Personal Health Clinic, focusing on STIs such as HIV and PrEP. Born in Japan and raised in Kenya, Africa, he is also licensed to practice in Kenya, where he participates in medical and educational support activities. He also serves as a visiting doctor at our clinic.
![](https://idaten.clinic/wp-content/uploads/2023/04/塩尻Photo-e1681615216113.jpg)