Sexuality in the Aging Couple, Part II: The Aging Male

Irwin W. Kuzmarov, MD, FRCSC; Jerald Bain, BScPhm, MD, MSc, FRCPC


Geriatrics and Aging. 2009;12(1):53-57. 

In This Article

Testosterone Therapies

Studies have shown that total testosterone does not correlate with levels of sexuality but that there are correlations between bioavailable testosterone and sexual desire and arousal, and erectile dysfunction occurs when the testosterone level falls below certain thresholds.[10,11,12]

It has been shown that testosterone levels decline with age; this progressive decline may begin as early as age 30.[13] Testosterone deficiency symptoms can include a loss of libido, fatigue, progressive decrease in muscle mass, erectile dysfunction, depression, and lack of concentration, as well as an increased risk of osteoporosis.[14] There is also evidence that testosterone can induce a response to phosphodiesterase type 5 inhibitors (PDE-5i's) in hypogonadal patients who have not responded to PDE-5 inhibitors prior to initiation of testosterone therapy. If there is evidence of hypogonadism, the addition of testosterone is indicated and may improve sexual interest. Recent evidence suggests that testosterone replacement among men with hypogonadism can provide significant sexual, physical, and psychological benefits.

Testosterone therapy is supplied in a variety of dosage forms, including oral, transdermal (gel or patch), and intramuscular preparations. With appropriate pretreatment investigations and regular assessments of efficacy, safety and treatment adherence, testosterone therapy can safely be used to improve the well-being of aging men experiencing symptoms of testosterone deficiency. It should be noted that there is emerging evidence for no increased risk of prostate cancer in men treated with testosterone therapy.[15]


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