Andropause - Testosterone replacement therapy for aging men

OBJECTIVE To review the rationale for treating symptomatic aging men whose testosterone levels are mildly reduced or low-normal with testosterone repl acement therapy. QUALITY OF EVIDENCE Large-scale multicentre prospective studies on the valu e of treating andropausal men with hormone therapy do not exist because the whole area of hormone therapy is barely 10 years old. Evidence presented i s based on physiologic studies, particularly studies in which treatment has been assessed. These were largely uncontrolled open studies. Studies to da te report positive responses to testosterone treatment with very few seriou s side effects. MAIN MESSAGE Physicians should consider hypoandrogenism If male patients co mplain of loss of libido, erectile dysfunction, weakness, fatigue, lethargy , loss of motivation, or mood swings. Less obvious associations with reduce d levels of testosterone are anemia and osteoporosis. The main cause of red uced testosterone production is primary gonadal insufficiency, but secondar y causes, such as hypothalamic-pituitary disease, should be considered. Evi dence shows that most men treated with testosterone will feel better about themselves and their lives. CONCLUSION Andropause is a term of convenience describing a complex of symp toms in aging men who have low testosterone levels. Physicians should be aw are of its existence, should consider ordering tests for men who have sympt oms, and should treat carefully selected patients whose serum testosterone levels are low.