Testosterone deficiency syndrome

Abstract

Over the last two decades, the age-associated decline of serum testosterone levels in men has received attention. It has become clear that age as such plays a role in this decline, but conditions occurring in old age, such as obesity, diabetes mellitus, and cardiovascular disease, often clustered in metabolic syndrome, are quantitatively more significant. It has also become clear that the age-associated decline of serum testosterone has clinical significance and symptoms of hypogonadism are manifested. The ailments of aging, such as osteoporosis, atherosclerosis, hypertension, cardiovascular disease, diabetes mellitus, lower urinary tract symptoms, and erectile dysfunction are traditionally regarded as distinct diagnostic/therapeutic entities, but there is a growing recognition that these entities are not disparate but interdependent in their etiology and that they require an integral diagnostic and therapeutic approach. Testosterone deficiency is a common denominator. Measurement of testosterone should be a pivotal component in the diagnostic workup of men suffering from the above conditions. And, if warranted by symptoms and laboratory findings, testosterone treatment should be given in addition to organ (system)-specific treatment. Traditionally, there has been a large degree of trepidation in administering testosterone to aging men for fear that testosterone treatment would worsen atherosclerosis resulting in cardiovascular disease, lower urinary tract symptoms, and malignant development of the prostate. These fears have not been substantiated in recent research. Professional scientific bodies have formulated guidelines for the responsible administration of testosterone to men with hypogonadism in whom lower-than-normal serum testosterone is found by laboratory tests.