Hypogonadism in the Aging Male Diagnosis, Potential Benefits, and Risks of Testosterone Replacement Therapy

Abstract

<jats:p>Hypogonadism in older men is a syndrome characterized by low serum testosterone levels and clinical symptoms often seen in hypogonadal men of younger age. These symptoms include decreased libido, erectile dysfunction, decreased vitality, decreased muscle mass, increased adiposity, depressed mood, osteopenia, and osteoporosis. Hypogonadism is a common disorder in aging men with a significant percentage of men over 60 years of age having serum testosterone levels below the lower limits of young male adults. There are a variety of testosterone formulations available for treatment of hypogonadism. Data from many small studies indicate that testosterone therapy offers several potential benefits to older hypogonadal men. A large multicenter NIH supported double blind, placebo controlled study is ongoing, and this study should greatly enhance the information available on efficacy and side effects of treatment. While safety data is available across many age groups, there are still unresolved concerns associated with testosterone therapy. We have reviewed the diagnostic methods as well as benefits and risks of testosterone replacement therapy for hypogonadism in aging men.</jats:p>

Sarcopenia and Androgens: A Link between Pathology and Treatment

“…Figure 1 shows the relationship between androgen levels and the development of sarcopenia. Androgen supplementation has been observed to exert anabolic actions that enhance muscle strength and increase muscle size clinically (27)(28)(29)(30)(31). Although the biological mechanisms underlying androgen action in skeletal muscle remain poorly understood, muscle mass has been observed to be regulated by the normal balance between synthesis and degradation of muscle proteins, a mechanism that is regulated by various systemic hormones.…”

“…With age, not only do testosterone levels decline progressively but SHBG levels also increase, further decreasing the amount of bioavailable Frontiers in Endocrinology | Endocrinology of Aging testosterone. The prevalence of hypogonadism is approximately 20% in men over 60 years and can reach 50% in men over 80 years (31). In young hypogonadal men, TRT has been associated with increase in lean mass, muscle strength, and muscle protein synthesis and decrease in fat mass.…”

Pemberian Testosterone Replacement Therapy Meningkatkan Ekspresi mRNA Reseptor Androgen pada Kelenjar Prostat Tikus Wistar (Rattus norvegicus) Jantan yang Dikastrasi

“…Testosteron replacement digunakan untuk terapi pengganti hormon testosteron pada pria, yang digunakan ketika terdapat tanda dan gejala klinis dari menurunnya level testosteron, yang bertujuan untuk mengurangi keluhan yang dialami oleh pria hipogonad. 11,12 Hasil studi pendahuluan pada 10 ekor tikus postkastrasi didapatkan terjadi peningkatan ekspresi mRNA AR pada kelompok yang diberikan testosteron, namun secara statistik tidak signifikan. 13 Berdasarkan kejadian tersebut dan karena hasil penelitian lalu masih kontroversi maka dilakukanlah penelitian ini untuk membuktikan peningkatan ekspresi mRNA AR pada prostat tikus postkastrasi setelah pemberian testosterone replacement therapy (TRT).…”

Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men – a suggested update

“…Other clinical symptoms of LOH include: erectile dysfunction, decreased vigor and muscle mass and strength, increased body fat, decreased bone mineral density and osteoporosis, decreased vitality, depressed mood and fatigue [21,22]. None of these symptoms are specific to the testosterone (T)-deficient state.…”