Testosterone: The Male HRT for Andropause

Drug Ther Perspect. 2000;16(10) 

In This Article

Introduction

Andropause describes the collection of symptoms associated with the age-related decline in gonadal function in men. In contrast to the rapid decline in ovarian function in women at menopause, at andropause men experience a gradual decline in testicular function and testosterone production. It is generally accepted that the decline in testosterone production is primarily testicular in origin. There is some evidence to suggest that the central component (i.e. alterations in the hypothalamic-pituitary-gonadal axis) may also have a role. Stress, illness, medications, obesity, malnutrition and psychiatric conditions, all common in the elderly, tend to reduce testosterone production. However, decreased plasma testosterone levels are also found in healthy elderly individuals.

The reduced testosterone production in men with hypogonadism results in diminished muscular strength, energy and libido, erectile dysfunction, depression, and osteoporosis and related fractures.

To manage these conditions of aging, the value of testosterone replacement is currently receiving considerable attention. The constellation of positive and negative effects associated with testosterone replacement means that the routine treatment of elderly individuals with hypogonadism cannot be recommended. Future development of selective androgen receptor modulators may provide beneficial effects without the adverse ones. Notwithstanding this, there are subgroups of elderly that benefit from testosterone replacement (see Patient care guidelines).

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