New Horizons in Testosterone and the Ageing Male

Tomás Ahern; Frederick C. W. Wu

Disclosures

Age Ageing. 2015;44(2):188-195. 

In This Article

Testosterone Therapy

Before considering testosterone therapy, one should ensure that testosterone levels are low, that the patient has features consistent with hypogonadism and that assessment for hypothalamic, pituitary and testicular disease is made.[20,21] A low testosterone level should be confirmed by second measurement due to large intra-individual variation in levels—the difference between two testosterone measurements on the same person exceeds 20% about half the time.[31] Blood for the determination of testosterone levels should be taken in the early morning and in the fasting state due to the significant diurnal variation in testosterone levels and the considerable effect of food intake on decreasing testosterone levels.[32]

Consideration should be given to specific therapies other than testosterone for remediable causes of hypogonadism. Dopamine agonist therapy is first-line therapy for men with hyperprolactinaemia and will increase testosterone levels[33] as will bariatric surgery for men with type 2 diabetes and/or severe obesity.[34] For the man with a low testosterone level who desires fertility, consideration should be given to gonadotrophin therapy or pulsatile gonadotrophin-releasing hormone therapy if LH levels are not elevated.[35]

Transdermal, intramuscular and buccal forms of testosterone therapy are safe and effective. Transdermal and buccal forms require daily administration, whereas intramuscular preparations are given every 3–12 weeks. Oral testosterone and 17-alpha-alkylated androgen preparations are not recommended due to potential liver toxicity and variable clinical response. More detailed recommendations on the practical aspects of testosterone therapy are available in published guidelines.[20,21]

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