The Role of Testosterone in the Elderly: What Do We Know?

Abstract

Testosterone is the most important hormone in male health. Aging is characterized by testosterone deficiency due to decreasing testosterone levels associated with low testicular production, genetic factors, adiposity, and illness. Low testosterone levels in men are associated with sexual dysfunction (low sexual desire, erectile dysfunction), reduced skeletal muscle mass and strength, decreased bone mineral density, increased cardiovascular risk and alterations of the glycometabolic profile. Testosterone replacement therapy (TRT) shows several therapeutic effects while maintaining a good safety profile in hypogonadal men. TRT restores normal levels of serum testosterone in men, increasing libido and energy level and producing beneficial effects on bone density, strength and muscle as well as yielding cardioprotective effects. Nevertheless, TRT could be contraindicated in men with untreated prostate cancer, although poor findings are reported in the literature. In addition, different potential side effects, such as polycythemia, cardiac events and obstructive sleep apnea, should be monitored. The aim of our review is to provide an updated background regarding the pros and cons of TRT, evaluating its role and its clinical applicability in different domains.

Erectile Dysfunction in Relation to Metabolic Disorders and the Concentration of Sex Hormones in Aging Men

“…The relationship between TT concentrations and ED is well established. The level of hypogonadism that induces ED is disputed and may be influenced by many factors, including extrinsic factors [19,20], patient age, and drug treatment [21]. It has been shown that low TT concentrations are directly related to higher BMI values.…”

Adipose Tissue Dysfunction and Obesity-Related Male Hypogonadism

“…One of the main therapeutic options for the treatment of functional hypogonadism is represented by testosterone replacement therapy (TRT) [ 122 ]. Interestingly, TRT might be an ally in promoting fat mass loss and improving metabolic outcomes through the direct actions of testosterone on AT function [ 10 , 123 ]. Indeed, the exogenous administration of testosterone undecanoate IM 1000 mg every 12 weeks was shown to lead to a significant decrease in body weight (~−15 kg), as well as waist circumference (~−12 cm) [ 124 , 125 ].…”

“…Obesity is also one of the key risk factors for many noncommunicable diseases, such as coronary heart disease, hypertension and stroke, certain types of cancer, type 2 diabetes, gallbladder disease, dyslipidemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnea, and represents one of the principal causes of secondary hypogonadism in men, a condition characterized by the impairment of the hypothalamic–pituitary–testicular (HPT) axis, in which the reduction in testosterone levels is also accompanied by signs and symptoms of hypogonadism, such as decreases in libido, erectile function, semen quality, strength, and mood [ 2 , 3 , 4 , 5 , 6 ]. The prevalence of hypogonadism in normal-weight adult males is around 32%, while about 75% of subjects with severe obesity (BMI > 40 kg/m 2 ) have from hypogonadism [ 7 , 8 , 9 , 10 ].…”

Late Adverse Health Outcomes and Quality of Life after curative radiotherapy + long-term ADT in Prostate Cancer Survivors: Comparison with men from the general population

“…Long-lasting hypogonadism rises the risk of physical and mental morbidity [25] , and explains the increased prevalence of depression and energy loss in our PCaSs. This finding, possibly more than sexual dysfunction itself, warrants the consideration of testosterone replacement therapy in long-term tumor-free PCaSs with severe symptoms and low serum testosterone [26] , and supports today’s shorter ADT duration, whenever possible.…”