Testosterone treatment in elderly men

Abstract

Testosterone has been used in testicular and hypothalamo-pituitary diseases since the 1940s. There is growing interest in the use of testosterone in aging men, and this has stimulated research into the benefits of male hormone replacement. Testosterone treatment of men with hypogonadism might have beneficial effects on body composition, muscle strength, sexual function, and cognition. There are several modes of administration of the male hormone, with injectable testosterone esters and implanted testosterone pellets being the mainstay of treatment until recently. These preparations are increasingly being replaced by transdermal patches, gels, and long-acting parenteral preparations. Testosterone patches and gels are ideally for elderly men. Treatment with the male hormone is relatively safe, if patients are selected appropriately and monitored carefully. The most important adverse effects are on the prostate. In this review, we briefly discuss the indications, contraindications, and benefits of testosterone treatment. Further, we list the adverse effects, advantages, and disadvantages of various testosterone preparations in elderly men.

Androgen Deficiency in Heart Failure

“…Similarly, in a group of frail men (age >65 years) exhibiting low or diminished testosterone levels, testosterone replacement therapy improved muscle strength and indicators of physical function [36], but the results of other studies were less convincing [37]. According to current best clinical practice, testosterone should be used with caution in elderly patients [3,37]. These guidelines advocate short-term testosterone therapy in HIV-infected men with low testosterone levels and weight loss (ie, patients with a mean age well below the fifth decade) "in order to promote weight maintenance and gains in lean body mass and muscle strength" [3].…”

“…However, while testosterone supplementation also increases lean body mass and muscle strength in the absence of exercise training in healthy young men [35], respective treatment effects were not constantly observed in elderly patients. Similarly, in a group of frail men (age >65 years) exhibiting low or diminished testosterone levels, testosterone replacement therapy improved muscle strength and indicators of physical function [36], but the results of other studies were less convincing [37]. According to current best clinical practice, testosterone should be used with caution in elderly patients [3,37].…”

Testosterone replacement therapy for physician assistants and nurse practitioners

“…The Endocrine Society as well as several other authors state that the normal range of serum testosterone depends on the laboratory performing the test and insurance companies. Regardless of what the normal values are, it is generally accepted that clinicians should correlate serum testosterone levels with the patient’s presenting symptoms when assessing the need for TRT ( 7 ).…”

“…These patients would present with low testosterone, FSH and LH levels ( 6 ). This is either due to underlying pathology within the pituitary gland or it can be due to problems with the hypothalamus ( 5 , 7 ). Prolactin, another hormone produced by the pituitary gland, directly inhibits GnRH production from the hypothalamus and hyperprolactinemia can also lead to secondary hypogonadism ( 5 ).…”

In Vitro Androgen Bioassays as a Detection Method for Designer Androgens

“…Androgen therapy can be administered orally, by intramuscular injection, and as gels and creams. Synthetic alkyl esters of androgens have been used therapeutically for decades due to their high potency and prolonged action [12]. The realization that androgen administration can augment muscle hypertrophy has led to the abuse of androgens to increase muscle size, strength and sport performance.…”