Aging Health (2009) 5(2), 227-245 of male primary hypogonadism is due to testicular failure, with Klinefelter's syndrome accounting for the majority of cases. Abnormalities at the testicular level result in hypergonadotropic hypogonadism (primary hypogonadism) and at the hypothalamic-pituitary level result in hypogonadotropic hypogonadism (secondary h ypogonadism) (Figure 1).In addition, it has been clearly demonstrated that aging is associated with a decline in both total T and free T levels, with a 20 and 35% incidence of hypogonadism in men aged 60 years and in those over 80 years of age, respectively [2,9]. This decline in T is the result of a combination of a primary steroidogenic defect in the aging Leydig cells [10], decreased pituitary secretory capacity and responsiveness to gonadotropin-releasing hormone [11]. This type of testicular deficiency has been termed late-onset hypogonadism (LOH). Aging is also asso ciated with an increase in sex hormone-binding globulin levels and, consequently, with a slower decline in total T than in free T [12]. The normal diurnal rhythm of T secretion observed in young men is partially lost with aging [13]. Aging is also associated with a decrease in lean body mass, muscle mass and strength, diminished libido, erectile function, decreased bone mass, increased fracture risk and diminished sleep quality -symptoms similar to those observed in hypogonadism, which may need treatment with T. Per definition, male hypogonadism is a clinical syndrome characterized by a reduction in circulating androgens and the presence of signs and symptoms of androgen deficiency. The existence of clinical symptoms is In demographic terms, the global population is estimated to grow from the current 6.5 billion to approximately 9 billion by the year 2050. However, owing to the worldwide prolongation of the mean life expectancy and the drastic reduction of fertility rate, it is projected that the elderly (>60 years) will double during the same period from 688-1964 million [1].Approximately 30% of men aged 60-70 years and 70% of men aged 70-80 years have low bioavailable or free testosterone (T) levels [2]. Symptoms and findings of T deficiency are more or less similar to those associated with aging. They include loss of energy, depressed mood, decreased libido, erectile dysfunction, decreased muscle mass and strength, increased fat mass, frailty, osteopenia and osteoporosis [3]. Clinical trials indicate that T therapy can improve many of these findings [4][5][6][7][8].Testosterone is the principal androgen in men, as well as the prohormone for the biosynthesis of two other sexual steroids: 5α-dihydrotestosterone (DHT) and 17β-estradiol. In human males, T 6-7 mg is secreted by the testes in a circadian rhythm with a nocturnal rise in T followed by a decline during the day. T is necessary for spermatogenesis, penile function, to induce and maintain secondary sexual characteristics, lean muscle mass, bone density and for normal sexual behavior and cognitive function.The administration of T is appropri...