Replacement therapy in the aging male

Abstract

In the aging male, endocrine changes and decline in endocrine function involve tissue responsiveness as well as reduced secretory output from peripheral glands and alterations in the central mechanism controlling the temporal organization of hormonal release. The latter are likely to be responsible for the dampened circadian hormonal and non-hormonal rhythms. These are in part responsible of the age dependent decrease of the peripheral levels of T, DHEA, the thyroid hormones, GH, IGF-I, and melatonin. These hormonal changes which develop in most men at about the age of 50 are in part responsible for the partial endocrine deficiencies of aging male (PEDAM). In cases of endocrine deficiencies, traditional endocrinology aims at replacing the missing hormone or hormones with substitutes. It has been demonstrated that interventions, such as hormone replacement therapies and use of antioxidant drugs may favorably influence some of the pathological conditions in aging men, by preventing the preventable and delaying the inevitable. A comprehensive medical, psycho-social and life-style history, a physical examination and laboratory testing are essential for the diagnosis and management of PEDAM. Acute, chronic or inter-current diseases must be taken into consideration prior to initiating any hormonal substitution therapy. Hormone substitution should only be performed by physicians with basic knowledge and clinical experience in diagnosis, treatment and monitoring of endocrine deficiencies. In the Era of Evidence Based Medicine, we have to acknowledge that data on hormone replacement therapy (HRT) in the aging male is mostly circumstantial, based on experience in treatment of transitional or chronic endocrine deficiencies in young men due to disease or experiments of nature. However over the past several years, there has been an increasing interest in evaluating whether male HRT might be beneficial for a specific category of older men in preventing or delaying some aspects of ageing, and a number of prospective studies on hormone replacement therapy in the aging male were performed and these are presented in detail.