The Decline of Androgen Levels in Elderly Men and Its Clinical and Therapeutic Implications
Jean M. Kaufman and
Alex Vermeulen
Department of Endocrinology, Ghent University Hospital, Ghent B-9000, Belgium
Correspondence: Address all correspondence and requests for reprints to: Prof. Dr. Jean M Kaufman, Department of Endocrinology 9K12, De Pintelaan 185, Ghent, B-9000, Belgium. E-mail: jean.kaufman{at}ugent.be
Aging in men is accompanied by a progressive, but individuallyvariable decline of serum testosterone production, more than20% of healthy men over 60 yr of age presenting with serum levelsbelow the range for young men. Albeit the clinical picture ofaging in men is reminiscent of that of hypogonadism in youngmen and decreased testosterone production appears to play arole in part of these clinical changes in at least some elderlymen, the clinical relevancy of the age-related decline in sexsteroid levels in men has not been unequivocally established.In fact, minimal androgen requirements for elderly men remainpoorly defined and are likely to vary between individuals. Consequently,borderline androgen deficiency cannot be reliably diagnosedin the elderly, and strict differentiation between "substitutive"and "pharmacological" androgen administration is not possible.To date, only a few hundred elderly men have received androgentherapy in the setting of a randomized, controlled study, andmany of these men were not androgen deficient. Most consistenteffects of treatment have been on body composition, but to datethere is no evidence-based documentation of clinical benefitsof androgen administration to elderly men with normal or moderatelylow serum testosterone in terms of diminished morbidity or ofimproved survival or quality of life. Until the long-term risk-benefitratio for androgen administration to elderly is establishedin adequately powered trials of longer duration, androgen administrationto elderly men should be reserved for the minority of elderlymen who have both clear clinical symptoms of hypogonadism andfrankly low serum testosterone levels.
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