Andropause or male menopause? Rationale for testosterone replacement therapy in older men with low testosterone levels

Abstract

Objective: To provide rationale for testosterone replacement therapy (TRT) in older men with low testosterone levels and symptoms consistent with testosterone deficiency.

Methods: The relevant literature was reviewed using PubMed.

Results: Cross-sectional and longitudinal population-based studies indicate that total and free testosterone levels fall with aging, and they may be accompanied by symptoms consistent with androgen deficiency. Testosterone treatment of younger men with very low testosterone levels and hypothalamic, pituitary, or testicular disease is associated with improvements in symptoms, body composition, bone density, and hematocrit/hemoglobin. Studies evaluating testosterone treatment of older men with low testosterone levels are limited, but they suggest some increase in fat free mass, some decrease in fat mass, and some increase in bone density of the lumbar spine and femoral neck.

Conclusion: The Testosterone Trial should provide definitive information regarding the potential benefits of TRT in men ≥65 years of age. If efficacy is confirmed, we will still need more information regarding the risks of TRT in older men.