Fertility and sexual life of men after their forties and in older age

Owing to the demographic development, the aging male will require more cons ideration in future. In contrast to a rapid decline of estradiol during men opause in women, the process of aging in the male is retarded and subject t o high individual variations. Impairment of spermatogenesis is observed as a continuous process occurring over decades. However, only about 50% of men in their eighties show complete loss of fertility. In principle, spermatog enesis may be retained well into senescence. Of importance for the individu al health condition is the fact that the number of Leydig cells declines wi th advancing age. Thus, altered sex hormone concentrations in aging men res ult from both functional disturbances and a gradual reduction in Leydig cel ls. Furthermore, an impaired feed-back mechanism of the pituitary-gonadal a xis occurs, with disappearance of the circadian testosterone (T) rhythm. LH and FSH levels are increased, and a reduced bioavailability of sex hormone s is observed. Lower total testosterone concentrations in men over 60 years are accompanied by clinical signs of reduced virility, such as decreased m uscle mass and strength as well as reduced sexual hair growth and libido. A n age-related decline in androgen secretion and plasma testosterone levels therefore suggests the use of androgen supplementation. However, there is a lack of risk-benefit long-term studies. Increased research in the male is mandatory to meet the requirements of the aging population. This should inc lude the availability of precise epidemiological data about the frequency o f partial androgen deficiency in aging males (PADAM).