Late-onset hypogonadism

Abstract

With aging, a significant percentage of men over the age of 60 years have serum testosterone levels below the lower limits of young adult men. Testosterone is not only pivotal for male reproductive/sexual functioning but plays also a significant role in the maintenance of bone and muscle mass and is a determinant of glucose homeostasis and lipid metabolism. The metabolic syndrome, erectile dysfunction and patterns of testosterone in aging men are intertwined. Testosterone is a factor in libido but also exerts essential effects on the anatomical and physiological substrate of penile erection. With these recent insights, the health problems of elderly men must be placed in a context that allows an integral approach. Treatment of testosterone deficiency is to become part of this approach. Recently, professional organizations have published guidelines in an attempt to define the condition and provide treatment. Despite this, much confusion still exists regarding the appropriate approach to diagnosing late-onset hypogonadism. Side effects concern mainly the prostate and erythropoeisis, but the currently available literature indicates that there is no increased risk of developing prostate cancer in men receiving testosterone treatment. Administration of testosterone to elderly men with testosterone deficiency is an acceptably safe practice.