Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/19017
Title: A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management.
Austin Authors: Grossmann, Mathis ;Matsumoto, Alvin M
Affiliation: Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
Geriatric Research, Education and Clinical Center, Seattle, Washington 98108
Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98195
Issue Date: 1-Mar-2017
Publication information: The Journal of Clinical Endocrinology and Metabolism 2017; 102(3): 1067-1075
Abstract: Middle-aged and older men (≥50 years), especially those who are obese and suffer from comorbidities, not uncommonly present with clinical features consistent with androgen deficiency and modestly reduced testosterone levels. Commonly, such men do not demonstrate anatomical hypothalamic-pituitary-testicular axis pathology but have functional hypogonadism that is potentially reversible. Literature review from 1970 to October 2016. Although definitive randomized controlled trials are lacking, evidence suggests that in such men, lifestyle measures to achieve weight loss and optimization of comorbidities, including discontinuation of offending medications, lead to clinical improvement and a modest increase in testosterone. Also, androgen deficiency-like symptoms and end-organ deficits respond to targeted treatments (such as phosphodiesterase-5 inhibitors for erectile dysfunction) without evidence that hypogonadal men are refractory. Unfortunately, lifestyle interventions remain difficult and may be insufficient even if successful. Testosterone therapy should be considered primarily for men who have significant clinical features of androgen deficiency and unequivocally low testosterone levels. Testosterone should be initiated either concomitantly with a trial of lifestyle measures, or after such a trial fails, after a tailored diagnostic work-up, exclusion of contraindications, and appropriate counseling. There is modest evidence that functional hypogonadism responds to lifestyle measures and optimization of comorbidities. If achievable, these interventions may have demonstrable health benefits beyond the potential for increasing testosterone levels. Therefore, treatment of underlying causes of functional hypogonadism and of symptoms should be used either as an initial or adjunctive approach to testosterone therapy.
URI: http://ahro.austin.org.au/austinjspui/handle/1/19017
DOI: 10.1210/jc.2016-3580
ORCID: 0000-0001-8261-3457
PubMed URL: 28359097
Type: Journal Article
Appears in Collections:Journal articles

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