Johannes D. Veldhuis, MD


March 15, 2000

In This Article


Sexual dysfunction in the elderly male is primarily associated with erectile rather than ejaculatory dysfunction. The latter is more often drug induced or associated with prostate surgery. In the hypogonadal male, reduced libido is often accompanied by diminished well being and/or depression that may be relieved by androgen replacement.[26]

Cognitive decline, visceral obesity, osteopenia, and relative sarcopenia also accompany androgen deficiency in aging.[27] These conditions respond favorably to androgen supplementation, especially in men with very low testosterone levels.[28] Enhanced physical performance has not been established in this context. Few studies have examined whether testosterone supplementation enhances cognitive function in elderly men.[29] Although it appears that neoplastic transformation of prostate tissue is not elicited by physiologic testosterone repletion, proliferation of existing androgen-responsive carcinomas may be stimulated. Thus, a normal prostate-specific antigen (PSA) and prostatic digital examination should precede any androgen treatment in older individuals.

Testosterone supplementation may worsen sleep apnea, induce gynecomastia, elicit erythrocytosis, and elevate blood pressure. Thus, the long-term safety of androgen supplementation in healthy adults requires further study.