Clinic and therapy of hypogonadism in aging males

Aging is accompanied by a progressive decline of testicular function. Where as fertility persists until a very old age, endocrine function declines pro gressively and at age 70 yrs, more than 25 % of men have hypogonadal testos terone levels. This decline in testosterone plays an important role in a se ries of signs and symptoms that accompany the aging process such as a decli ne in virility, in libido and sexual activity, muscle mass: and strength, d ecline in bone mass (osteoporosis), an increase in abdominal fat mass and a decrease in the feeling of general well being. Most of these signs and sym ptoms have a multifactorial origin, nevertheless, androgen substitution gen erally improves most of these symptoms, increasing muscle mass and strength , improving libido and sexual activity, decreasing abdominal fat and improv ing insulin sensitivity as well as the sense of well being, effects which s uggest a role of androgen deficiency in their genesis. Side effects of this substitutive therapy, mainly at the level of the prostate, with possible s timulation of a prostatic carcinoma, should be carefully looked for. Before starting any androgen therapy, the presence of a prostatic carcinoma shoul d be excluded by rectal examination and PSA measurement, eventually, in cas e of doubt, complemented by transrectal echography. Presence of a prostatic carcinoma is an absolute contraindication for androgen therapy. During tre atment, development of side effects should be traced by a six monthly recta l examination and PSA determination as well by monitoring of haematocrite a nd lipid profile.