Androgen deficiency in older men

Abstract

BACKGROUND: Older men, especially those who are overweight or obese and have comorbidities, not uncommonly present with non-specific androgen deficiency-like symptoms, such as low energy and sexual dysfunction, and modestly lowered serum testosterone relative to reference ranges based on healthy young men. OBJECTIVE: The aim of this paper is to describe the clinical approach to men who present with non-specific androgen deficiency-like symptoms. DISCUSSION: Most men who present with non-specific androgen deficiency-like symptoms do not have organic hypogonadism due to pituitary or testicular disease, but instead have functional gonadal axis suppression due to ill health. Lifestyle measures - especially weight loss, optimisation of comorbidities and cessation of offending medications - can improve symptoms and increase serum testosterone; this should be the first-line approach. Recent randomised controlled trials (RCTs) have reported modest benefits of testosterone treatment in stringently selected older men. However, the true long-term risks and benefits of testosterone treatment in such men are not known. Further study is required before testosterone treatment can be routinely recommended for indications other than organic hypogonadism.