'Andropause', like menopause, has received significant attention in recent
years. It results in a variety of symptoms experienced by the elderly. Many
of these symptoms are nonspecific and vague. For this reason, many authors
have questioned the value of androgen replacement in this population. Also
in dispute is the normal cutoff level for testosterone beyond which therap
y should be initiated, and whether to measure free or total testosterone. T
estosterone levels;decline with age, with the lowest level seen in men olde
r than 70 years. This age-related decline in testosterone levels is both ce
ntral (pituitary) and peripheral (testes) in origin. With aging, there is a
lso a loss of circadian rhythm of testosterone secretion and a rise in sex
hormone binding globulin (SHBG) levels. Total testosterone level is the bes
t screening test for patients with suspected hypogonadism. If the total tes
tosterone concentration is low, free testosterone levels should be obtained
. Prostate cancer remains an absolute contraindication to androgen therapy.
Testosterone replacement results in an improvement in muscle strength and
bone mineral density. Similar effects are observed on the haematopoietic sy
stem. Data on cognition and lipoprotein profiles are conflicting. Androgen
therapy can result in polycythemia and sleep apnoea. These adverse effects
can be deleterious in men with compromised cardiac reserve. We recommend th
at elderly men with symptoms of hypogonadism and a total testosterone level
<300 ng/dl should be started on testosterone replacement. This review disc
usses the pros and cons of testosterone replacement in hypogonadal elderly
men and attempts to answer some of the unanswered questions. Furthermore, e
mphasis is made on the regular follow-up of these patients to prevent the d
evelopment of therapy-related complications.