Testosterone and andropause: The feasibility of testosterone replacement therapy in elderly men

Andropause, a syndrome in aging men, consists of physical, sexual, and psyc hologic symptoms that include weakness, fatigue, reduced muscle and bone ma ss, impaired hematopoiesis, oligospermia, sexual dysfunction, depression, a nxiety, irritability, insomnia, memory impairment, and reduced cognitive fu nction. Free testosterone levels begin to decline at a rate of 1% per year after age 40 years. It is estimated that 20% of men aged 60-80 years have l evels below the lower limit of normal. Although the causal relationship bet ween declining testosterone levels and development of andropause symptoms i s not firmly established, administration of testosterone to this population resulted in improvements in many areas. Most studies to date focused on ph ysical benefits of testosterone replacement and failed to assess psychologi c symptoms rigorously. Preliminary data suggest that therapy may benefit el derly men with new-onset depression. Testosterone administration is not wit hout problems, the most worrisome being the potential for increased prostat e cancer risk. Despite this concern, a limited number of studies administer ed the hormone weekly for up to 2 years, with only mild increases in prosta te-specific antigen over control values. Currently, insufficient evidence, primarily regarding psychologic safety and efficacy, exists to warrant gene ral administration of testosterone to elderly hypogonadal men. Further clin ical investigations of this therapy in men with low testosterone levels and andropause symptoms are justified and necessary.