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.

Symptoms of LOH

– 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.”

Severity Assessment

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.

Initial Blood Test Set

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)

STI Screening (Optional): HIV, Hepatitis B, Syphilis, Gonorrhea, Chlamydia (testing of genital, throat, and anal areas) (10,000 JPY) [Usually 24,000 JPY]

Treatment for Male Menopause (Late-Onset Hypogonadism)

Treatment for male menopause generally falls into three main categories: lifestyle modifications, testosterone therapy and ED medications.

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.

Testosterone Therapy

Available Options:

Injections: Short-acting testosterone (Testviron), 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.

What is “Nebido”?

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).

Cernos Injection

Description: A long-acting injectable testosterone formulation. The frequency of administration varies depending on individual conditions. This is recommended for those with more severe symptoms or those seeking noticeable treatment effects. Once stabilized, treatment every 3-4 months is possible.

Price: 18,000 JPY (includes testosterone level testing)

Cernos Gel

Description: A long-acting topical testosterone formulation. Dosage and prescription volume may vary depending on the individual’s condition. It offers an affordable treatment option and allows for flexible adjustment of treatment intensity.

Please consult with your doctor during your visit for details.

Price: 4,000-9,000 JPY/month

Cernos Capsules

Description: A long-acting oral testosterone formulation. Initially, 1 to 2 capsules per day is generally recommended. Dosage may be adjusted based on symptoms.

1 box: 5,000 JPY / 30 capsules

3 boxes: 14,000 JPY / 90 capsules

6 boxes: 27,000 JPY / 180 capsules

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) 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.

Regular Blood Test Set

Hormone Level Measurement: Testosterone, Free Testosterone (3,000 JPY)

Lifestyle Disease Screening (Optional): Complete blood count, liver function, kidney function, electrolytes, uric acid, CK, TG, LDL, HDL, blood glucose, HbA1c (3,000 JPY)

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.

Price

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.

Cost Calculation

[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 and Follow-up Fees

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
(24,000)
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

[After Starting Hormone Therapy]

Type of Test Price (JPY) Results*
Hormone Test
[Testosterone + Free Testosterone]
3,000 4-5 days
Metabolic Syndrome Screening
(Optional)
3,000 2-3 days
D-dimer
[Thrombosis Risk Assessment]
(Optional)
1,500 2-3 days

* 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 Formulation Price (JPY)
Long-acting
Testosterone
Nebido Generic Oral
(Cernos Capsule)
1 box: 5,000 / 30 capsules
3 boxes: 14,000 / 90 capsules
6 boxes: 27,000 / 180 capsules
Nebido Generic
(Cernos Injection)
18,000*
Testosterone Cream Cernos Gel
(1% Testosterone Undecanoate Topical)
4,000-9,000/month**
Glomin
(1% Testosterone Topical)
4,100
1UP Formula
(5% Testosterone Topical)
Prescription Fee: 2,200
(+ medication cost)***
Short-acting
Testosterone
Testoviron 100mg 2,500
Testoviron 250mg 3,500

*Includes the cost of hormone level testing.

**Dosage and amount may vary depending on each patient’s individual condition. Please consult your doctor during your visit.

***For 1UP Formula, you will pay a prescription fee of 2,200 JPY at our clinic and purchase the medication separately at a specialized pharmacy (approx. 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)
Stendra


Avanafil
(Generic)
*Stendra is not available
Avanafil 100mg 1,100 (1 tablet)
9,000 (10 tablets)
Avanafil 200mg 1,200 (1 tablet)
10,000 (10 tablets)
Trial Package Tadalafil 10mg +
Vardenafil 10mg +
Sildenafil 50mg
3,400
Tadalafil 10mg +
Vardenafil 10mg +
Sildenafil 50mg +
Avanafil 100mg
4,000

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.

Step 1

Make an Appointment

Please make an appointment through the “In-Person Consultation” section on our official website.

Step 2

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.

Step 3

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.

Step 4

Doctor Consultation and Examination

Based on your questionnaire, we will provide appropriate advice, tests, and treatment as needed.

This article is supervised by:

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.