Androgen deficiency in older men.

Abstract

Older men, especially those who are overweight or obese and have comorbidities, not uncommonly present with non-specific androgen deficiency-like symptoms, such as low energy and sexual dysfunction, and modestly lowered serum testosterone relative to reference ranges based on healthy young men. The aim of this paper is to describe the clinical approach to men who present with non-specific androgen deficiency-like symptoms. Most men who present with non-specific androgen deficiency-like symptoms do not have organic hypogonadism due to pituitary or testicular disease, but instead have functional gonadal axis suppression due to ill health. Lifestyle measures - especially weight loss, optimisation of comorbidities and cessation of offending medications - can improve symptoms and increase serum testosterone; this should be the first-line approach. Recent randomised controlled trials (RCTs) have reported modest benefits of testosterone treatment in stringently selected older men. However, the true long-term risks and benefits of testosterone treatment in such men are not known. Further study is required before testosterone treatment can be routinely recommended for indications other than organic hypogonadism.