Human Reproduction Update, Vol.8, No.5 pp.423-433, 2002
© European Society of Human Reproduction and Embryology 2002; all rights reserved
Androgens and the ageing male
1 Department of Growth and Reproduction GR, Rigshospitalet section 5064, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
To whom correspondence should be addressed at: Anders Juul, Department of Growth and Reproduction GR, Rigshospitalet section 5064, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. e-mail: ajuul{at}dadlnet.dk
Abstract
Hypogonadal men share a variety of signs and symptoms such as decreased muscle mass, osteopoenia, increased fat mass, fatigue, decreased libido and cognitive dysfunctions. Controlled trials have demonstrated favourable effects of androgen substitution therapy on these signs and symptoms in men with severe primary or secondary hypogonadism. Thus, androgen substitution therapy is warranted in men with true hypogonadism at all ages. Symptoms experienced by otherwise healthy ageing males are non-specific and vague, although some may be similar to symptoms of hypogonadism. Therefore, the term ‘andropause’ has been suggested. However, testosterone levels show no or only modest variation with age in men; with large prospective studies suggesting a maximal decline of total testosterone of 1.6% per year. Thus, in contrast to the sudden arrest of gonadal activity in females around menopause, men do not have an andropause. As large placebo-controlled studies of androgen treatment in elderly males are lacking, proper risk assessment of adverse effects such as prostate cancer following testosterone treatment in elderly males is completely lacking. In the future, testosterone therapy may prove beneficial in some elderly males with low–normal testosterone levels. However, at this point in time, widespread use of testosterone in an elderly male population outside controlled clinical trials seems inappropriate.
Key words: ageing / hypogonadism / male andropause / testosterone
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