Skip to main content

Advertisement

SpringerLink
Log in

Risks Versus Benefits of Testosterone Therapy in Elderly Men

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

‘Andropause’, like menopause, has received significant attention in recent years. It results in a variety of symptoms experienced by the elderly. Many of these symptoms are nonspecific and vague. For this reason, many authors have questioned the value of androgen replacement in this population. Also in dispute is the normal cutoff level for testosterone beyond which therapy should be initiated, and whether to measure free or total testosterone. Testosterone levels decline with age, with the lowest level seen in men older than 70 years. This age-related decline in testosterone levels is both central (pituitary) and peripheral (testes) in origin. With aging, there is also a loss of circadian rhythm of testosterone secretion and a rise in sex hormone binding globulin (SHBG) levels. Total testosterone level is the best screening test for patients with suspected hypogonadism. If the total testosterone concentration is low, free testosterone levels should be obtained. Prostate cancer remains an absolute contraindication to androgen therapy. Testosterone replacement results in an improvement in muscle strength and bone mineral density. Similar effects are observed on the haematopoietic system. Data on cognition and lipoprotein profiles are conflicting. Androgen therapy can result in polycythemia and sleep apnoea. These adverse effects can be deleterious in men with compromised cardiac reserve. We recommend that elderly men with symptoms of hypogonadism and a total testosterone level <300 ng/dl should be started on testosterone replacement. This review discusses the pros and cons of testosterone replacement in hypogonadal elderly men and attempts to answer some of the unanswered questions. Furthermore, emphasis is made on the regular follow-up of these patients to prevent the development of therapy-related complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jeffcoate SL, Brocks RV, Lin NY, et al. Androgen production in hypogonadal men. J Endocrinol 1967; 37: 401–11

    Article  PubMed  CAS  Google Scholar 

  2. Wheeler MJ. Determination of bio-available testosterone. Ann Clin Biochem 1995; 32: 345–57

    PubMed  CAS  Google Scholar 

  3. Ekins R. Measurement of free hormones in blood. Endocr Rev 1990; 11: 5–46

    Article  PubMed  CAS  Google Scholar 

  4. Meikel CM. The free hormone hypothesis: a physiologically based mathematical model. Endocr Rev 1989; 10: 232–74

    Article  Google Scholar 

  5. Bremner WJ, Vitiello V, Prinz PN. Loss of circadian rhythmicity in blood testosterone levels with aging in normal men. J Clin Endocrinol Metab 1983; 56: 1278–81

    Article  PubMed  CAS  Google Scholar 

  6. Vermeulen A, Rubens R, Verdonck L. Testosterone secretion and metabolism in male senescence. J Clin Endocrinol Metab 1972; 34: 730–5

    Article  PubMed  CAS  Google Scholar 

  7. Stearns EL, MacDonell JA, Kauffman BJ, et al. Declining testicular function with aging: hormonal and clinical correlates. Am J Med 1974; 57: 761–6

    Article  PubMed  CAS  Google Scholar 

  8. Baker HWG, Burger HG, de Kretser DM, et al. Endocrinology of aging: pituitary testicular axis. Clin Endocrinol (Oxf) 1976; 5: 349–72

    Article  CAS  Google Scholar 

  9. Vermeulen A. Androgens in the aging male. J Clin Endocrinol Metab 1991; 73: 221–4

    Article  PubMed  CAS  Google Scholar 

  10. Gray A, Feldman HA, McKinley JB, et al. Age, disease and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab 1991; 73: 1016–25

    Article  PubMed  CAS  Google Scholar 

  11. Purifoy FE, Koopmans LH, Mayes DM. Age differences in serum androgen levels in normal adult males. Hum Biol 1981; 57: 71

    Google Scholar 

  12. Deslypere JP, Vermeulen A. Leydig cell function in normal men: effect of age, life-style, residence, diet, and activity. J Clin Endocrinol Metab 1984; 59: 955–62

    Article  PubMed  CAS  Google Scholar 

  13. Morley JE, Kaiser FE, Perry III HM, et al. Longitudinal changes in testosterone, LH, and FSH in healthy older men. Metabolism 1997; 46(4): 410–3

    Article  PubMed  CAS  Google Scholar 

  14. Harman SM, Tsitouras PD. Reproductive hormones in aging men. I. Measurement of sex steroids, basal luteinizing hormone, and leydig cell response to human chorionic gonadotropin. J Clin Endocrinol Metab 1980; 51: 35–40

    Article  PubMed  CAS  Google Scholar 

  15. Tenover JS, Matsumoto AM, Plymate SR, et al. The effects of aging in normal men on bioavailable testosterone and luteinizing hormone secretion: response to clomiphine citrate. J Clin Endocrinol Metab 1987; 65: 1118–26

    Article  PubMed  CAS  Google Scholar 

  16. Morley JE, Kaiser F, Raum WJ, et al. Potentially predictive and manipulable blood serum correlates of aging in the healthy human male: progressive decreases in bioavailable testosterone, dehydroepiandrosterone sulfate, and the ratio of insulinlike growth factor 1 to growth hormone. Proc Natl Acad Sci 1997; 94: 7537–42

    Article  PubMed  CAS  Google Scholar 

  17. Sniffen RC. The testes. I. The normal testes. Arch Pathol 1950; 50: 259–84

    CAS  Google Scholar 

  18. Tillinger KG. Testicular morphology. Acta Endocrinol Suppl (Copenh) 1957; Suppl. 30: 1–192

    Google Scholar 

  19. Harbitz TB. Morphometric study of Leydig cells in elderly men with special reference to the histology of the prostate. Acta Pathol Microbiol Scand 1973; 81: 301–13

    CAS  Google Scholar 

  20. Neaves WB, Johnson L, Porter JC, et al. Leydig cell numbers, daily sperm production and serum gonadotrophin levels in aging men. J Clin Endocrinol Metab 1984; 59: 756–63

    Article  PubMed  CAS  Google Scholar 

  21. Sasano M, Ishyo S. Vascular patterns of the human testes with special reference to its senile changes. Tohoku J Exp Med 1969; 99: 269–80

    Article  PubMed  CAS  Google Scholar 

  22. Suoranta H. Changes in small blood vessels of the adult human testes in relation to age and some pathological conditions. Virchows Arch Pathol Anat Physiol Klin Med 1971; 352: 765–81

    Google Scholar 

  23. Vermeulen A, Desylpere JP. Intratesticular unconjugated steroids in elderly men. J Steroid Biochem 1986; 24: 1079–89

    Article  PubMed  CAS  Google Scholar 

  24. Desylpere JP, Vermeulen A. Leydig cell function in normal men: effect of age, lifestyle, residence, diet and activity. J Clin Endocrinol Metab 1989; 68: 68–72

    Article  Google Scholar 

  25. Vermeulen A, Desylpere JP, Kaufman JM. Influence of antiopioids and luteinizing hormone pulsatility in aging men. J Clin Endocrinol Metab 1989; 68: 68–72

    Article  PubMed  CAS  Google Scholar 

  26. Winters SJ, Sherins RJ, Troen P. The gonadotropin suppressive activity of androgens is increased in elderly men. Metabolism 1984; 33: 1052–9

    Article  PubMed  CAS  Google Scholar 

  27. Desylpere JP, Kaufman JM, Vermeulen T, et al. Influence of age on pulsatile luteinizing hormone release and responsiveness of the ganadotrophs to sex hormone feedback in men. J Clin Endocrinol Metab 1987; 64: 68–73

    Article  Google Scholar 

  28. McConnell JD. Prostatic growth: new insights into hormonal regulation. Br J Urol 1995; 76Suppl. 1: 5–10

    PubMed  CAS  Google Scholar 

  29. Horton R. Benign prostatic hyperplasia: a disorder of androgen metabolism in the male. J Am Geriatr Soc 1984; 32: 380–85

    PubMed  CAS  Google Scholar 

  30. Wilson JD. Recent studies on the mechanism of action of testosterone. N Engl J Med 1972; 287: 1284–94

    Article  PubMed  CAS  Google Scholar 

  31. Rogers C, Coffey D, Cunha G, et al. Benign prostatic hyperplasia. Vol. II. Bethesda (MD): US Department of Health and Human Service. NIH publication no: 87-2881

  32. McConnell JD. The pathophysiology of BHP. J Androl 1991; 12: 356–63

    PubMed  CAS  Google Scholar 

  33. Liao S, Fang S. Receptor proteins for androgens and the mode of action of androgens on gene transcription in ventral prostate. Vitam Horm 1969; 27: 17–26

    Article  PubMed  CAS  Google Scholar 

  34. Hulka BS, Hammond JE, DiFerdinando G, et al. Serum hormone levels among patients with prostatic carcinoma or benign prostatic hyperplasia and clinic controls. Prostate 1987; 11: 171–82

    Article  PubMed  CAS  Google Scholar 

  35. Carter HB, Pearson JD, Metter EJ, et al. Longitudinal evaluation of serum androgen levels in men with and without prostate cancer. Prostate 1995; 27: 25–31

    Article  PubMed  CAS  Google Scholar 

  36. Gann PH, Hennekens CH, Longcope C, et al. A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia. Prostate 1995; 26: 40–9

    Article  PubMed  CAS  Google Scholar 

  37. McConnell JD, Wilson JD, George FW, et al. Finasteride, an inhibitor of 5-alpha reductase, suppresses prostatic dihydrotestosterone in men with benign prostatic hyperplasia. J Clin Endocrinol Metab 1992; 74: 505–8

    Article  PubMed  CAS  Google Scholar 

  38. Ekman P. A risk benefit assessment of treatment with Finasteride in benign prostatic hyperplasia. Drug Saf 1998; 18(3): 161–70

    Article  PubMed  CAS  Google Scholar 

  39. Stone NN, Clejan SJ. Response of prostate volume, prostate specific antigen, and testosterone to flutamide in men with benign prostatic hyperplasia. J Androl 1991; 12: 376–80

    PubMed  CAS  Google Scholar 

  40. Peters CA, Walsh PC. The effect of nafarelin acetate, a luteinizing-hormone-releasing hormone agonist, on benign prostatic hyperplasia. N Engl J Med 1987; 317: 599–604

    Article  PubMed  CAS  Google Scholar 

  41. Tenover JS. Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab 1992; 75: 1092–8

    Article  PubMed  CAS  Google Scholar 

  42. Hartnell J, Korenman SG, Viosca SP. Results of testosterone enanthate therapy for hypogonadism in older men. Proceedings of the 72nd Annual Meeting of The Endocrine Society; 1990 Jun; 428

  43. Hajjar RR, Kaiser FE, Morley JE. Outcomes of long-term testosterone replacement in older hypogonadal males: a retrospective analysis. J Clin Endocrinol Metab 1997; 82: 3793–6

    Article  PubMed  CAS  Google Scholar 

  44. Behre HM, Bohmeyer J, Nieschlag E. Prostate volume in testosterone treated and untreated hypogonadal men in comparison to age-matched normal controls. Clin Endocrinol 1994; 40: 341–9

    Article  CAS  Google Scholar 

  45. Meikle AW, Arver S, Dobs AS, et al. Prostate size in hypogonadal men treated with a nonscrotal permeation-enhanced testosterone transdermal system. Urology 1997; 49: 191–6

    Article  PubMed  CAS  Google Scholar 

  46. Marin P, Holmang S, Gustafsson C, et al. Androgen treatment of abdominally obese men [abstract]. Obes Res 1993; 1: 245

    PubMed  CAS  Google Scholar 

  47. Orwoll E, Oviatt S, Biddle J, et al. Transdermal testosterone supplementation in normal older men [abstract no. 1071]. Programs and Abstracts of the 74th Annual Meeting of the Endocrine Society; 1992 Jun 24–27; San Antonio, 319

  48. Melton III LJ. Epidemiology of fractures. In: Riggs BL, Melton III LJ, editors. Osteoporosis, etiology, diagnosis, and management. New York: Raven Press, 1988: 133–54

    Google Scholar 

  49. Genant HK, Cann CE, Pozzi-Mucelli S, et al. Vertebral mineral determination by quantitative CT: clinical feasibility and normative data [abstract]. J Comput Assist Tomogr 1981; 7: 554

    Article  Google Scholar 

  50. Meier DE, Orwoll ES, Jones JM. Marked disparity between trabecular and cortical bone loss with age in healthy men. Ann Intern Med 1984; 101: 605–12

    PubMed  CAS  Google Scholar 

  51. Riggs BL, Wahner HW, Dunn WL, et al. Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spin osteoporosis. J Clin Invest 1981; 67: 328–35

    Article  PubMed  CAS  Google Scholar 

  52. Orwoll ES, Oviatt S, McClung MR, et al. The rate of bone mineral loss in normal men and the effects of calcium and cholecalciferol supplementation. Ann Intern Med 1990; 112: 29–34

    PubMed  CAS  Google Scholar 

  53. Drinka PJ, Bauwens SF. Male osteopenia: a brief review. J Am Geriatr Soc 1987; 35: 258–61

    PubMed  CAS  Google Scholar 

  54. Seeman E, Melton LJ, O’Fallon WM, et al. Risk factors for spinal osteoporosis in men. Am J Med 1983; 75: 977–83

    Article  PubMed  CAS  Google Scholar 

  55. Smith DAS, Walker MS. Changes in plasma steroids and bone density in Klinefelter’s syndrome. Calcif Tissue Res 1977; 22: 225–8

    Article  PubMed  Google Scholar 

  56. Lewinnek GE, Kelsey J, White AA, et al. The significance and a comparative analysis of the epidemiology of hip fractures. Clin Orthoped 1980; 152: 35–43

    Google Scholar 

  57. Jackson JA, Riggs MW, Spiekerman AM. Testosterone deficiency as a risk factor for hip fractures in men: a case-control study. Am J Med Sci 1992; 304(1): 4–8

    Article  PubMed  CAS  Google Scholar 

  58. Ongphiphadhanakul B, Rajatanavin R, Chailurkit L, et al. Serum testosterone and its relation to bone mineral density and body composition in normal males. Clin Endocrinol 1995; 43: 727–33

    Article  CAS  Google Scholar 

  59. Finkelstein JS, Klibanski A, Neer RM, et al. Increases in bone density during treatment of men with idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab 1989; 69: 776–83

    Article  PubMed  CAS  Google Scholar 

  60. Goldray D, Weisman Y, Jaccard N, et al. Decreased bone density in elderly men treated with gonadotropin-releasing hormone agonist decapeptyl (D-Trp6-GnRH). J Clin Endocrinol Metab 1993; 76: 288–90

    Article  PubMed  CAS  Google Scholar 

  61. Stepan JJ, Lachman M, Zverina J, et al. Castrated men exhibit bone loss: effect of calcitonin treatment on biochemical indices of bone remodelling. J Clin Endocrinol Metab 1989; 69: 523–7

    Article  PubMed  CAS  Google Scholar 

  62. Greenspan SL, Oppenheim DS, Klibanski A. Importance of gonadal steroids to bone mass in men with hyperprolactinemic hypogonadism. Ann Intern Med 1989; 110: 526–31

    PubMed  CAS  Google Scholar 

  63. Albright F, Reifenstein EC. Metabolic bone disease: osteoporosis. In: Williams, editor. The parathyroid glands and metabolic bone disease. Baltimore (MD): Williams and Wilkins, 1948: 145

    Google Scholar 

  64. Lafferty FW, Spencer GE, Pearson OH. Effects of androgens, estrogens and high calcium intakes on bone formation and resorption in osteoporosis. Am J Med 1964; 36: 514–28

    Article  PubMed  CAS  Google Scholar 

  65. Oppenheim D, Klibanski A. Osteopenia in men with acquired hypogonadism: improvement with testosterone replacement [abstract no. 585]. Programs and Abstracts of the 71st Meeting of The Endocrine Society; 1989 Jun: 289

  66. Morley JE, Perry HM, Kaiser FE, et al. Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study. J Am Geriatr Soc 1993; 41: 149–52

    PubMed  CAS  Google Scholar 

  67. Katznelson L, Finkelstein JS, Schoenfeld DA, et al. Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism. J Clin Endocrinol Metab 1996; 81: 4358–65

    Article  PubMed  CAS  Google Scholar 

  68. Behre HM, Kliesch S, Leifke E, et al. Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab 1997; 82: 2386–90

    Article  PubMed  CAS  Google Scholar 

  69. Kochakian CD. Comparison of protein anabolic property of various androgens in the castrated rat. Am J Physiol 1950; 60: 553–8

    Google Scholar 

  70. Forbes GB, Reina JC. Adult lean body mass declines with age: some longitudinal observations. Metabolism 1970; 19: 653–63

    Article  PubMed  CAS  Google Scholar 

  71. Kallman DA, Plato CA, Tobin JD. The role of muscle loss in the age-related decline of grip strength: cross-sectional and longitudinal perspectives. J Gerontol 1990; 45: M82–8

    PubMed  CAS  Google Scholar 

  72. Shimokata H, Tobin JD, Muller DC, et al. Studies in the distribution of body fat. I. Effects of age, sex, and obesity. J Gerontol 1989; 44: M66–73

    PubMed  CAS  Google Scholar 

  73. Seidell JC, Bjorntorp P, Sjostrom L, et al. Visceral fat accumulation in men is positively associated with insulin, glucose and C-peptide levels, but negatively with testosterone levels. Metabolism 1990; 39: 897–901

    Article  PubMed  CAS  Google Scholar 

  74. Marin P, Oden B, Bjorntop P. Assimilation and mobilization of triglycerides in subcutaneous abdominal and femoral adipose tissue in vivo in men: effects of androgens. J Clin Endocrinol Metab 1995; 80: 239–43

    Article  PubMed  CAS  Google Scholar 

  75. Rogers MA, Evans WJ. Changes in skeletal muscle with aging: effects of exercise training. Exerc Sport Sci Rev 1993; 21: 65–102

    Article  PubMed  CAS  Google Scholar 

  76. Spencer H, Lewin I, Friedland JA. Actions of androgens and related substances on mineral metabolism and bone [abstract]. Pharmacol Ther 1976; 1: 207

    CAS  Google Scholar 

  77. Bergamini E. Testosterone and sugar transport in levator ani muscle of rat. Biochim Biophys Acta 1969; 193: 193–202

    Article  PubMed  CAS  Google Scholar 

  78. Breuer CB, Florini JR. Effects of ammonium sulphate, growth hormone and testosterone propionate on ribonucleic acid polymerase and chromatin activities in rat skeletal muscle. Biochemistry 1966; 5: 3857–65

    Article  CAS  Google Scholar 

  79. Powers ML, Florini JR. A direct effect of testosterone on muscle cells in tissue culture. Endocrinology 1975; 97: 1043–7

    Article  PubMed  CAS  Google Scholar 

  80. Bhasin S, Storer TW, Berman N, et al. Anabolic effects of androgens: testosterone increases lean body mass, muscle size and strength in hypogonadal men [abstract]. The 19th Annual Meeting of the American Society of Andrology; 1994 Nov: 40

  81. Friedl KE, Dettori JR, Hannan CJ, et al. Comparison of the effects of high dose testosterone and 19-nortestosterone to a replacement dose of testosterone on strength and body composition in normal men. J Steroid Biochem Molec Biol 1991; 40: 607–12

    Article  PubMed  CAS  Google Scholar 

  82. Griggs RC, Kingston W, Jozefowics RF, et al. Effect of testosterone on muscle mass and muscle protein synthesis. J Appl Physiol 1989; 66: 498–503

    PubMed  CAS  Google Scholar 

  83. Young NR, Baker HWG, Liu G, et al. Body composition and muscle strength in healthy men receiving testosterone enanthate for contraception. J Clin Endocrinol Metab 1993; 77: 1028–32

    Article  PubMed  CAS  Google Scholar 

  84. Wang C, Eyre DR, Clark R, et al. Sublingual testosterone replacement improves muscle mass and strength, decreases bone resorption, and increases bone formation markers in hypogonadal men: a clinical research center study. J Clin Endocrinol Metab 1996; 81: 3654–62

    Article  PubMed  CAS  Google Scholar 

  85. Bhasin S, Storer T, Strakora J, et al. Testosterone increases lean body mass, muscle size and strength in hypogonadal men [abstract]. Clin Res 1994; 42: 74A

    Google Scholar 

  86. Wong FHW, Pun KK, Wang C. Loss of bone mass in patients with Kleinfelter’s syndrome despite sufficient testosterone replacement. Osteoporos Int 1993; 7: 281–7

    Google Scholar 

  87. Brodsky IG, Balagopal P, Nair KS. Effects of testosterone replacement on muscle mass and muscle protein synthesis in hypogonadal men: a clinical research study. J Clin Endocrinol Metab 1996; 81: 3469–75

    Article  PubMed  CAS  Google Scholar 

  88. Urban RJ, Bodenburg YH, Gilkison C, et al. Testosterone administration to elderly men increases skeletal muscle strength and protein synthesis. Am J Physiol 1995; 269: E820–26

    PubMed  CAS  Google Scholar 

  89. Sih R, Morley JE, Kaiser FE, et al. Testosterone replacement in older hypogonadal men: a 12-month randomised controlled trial. J Clin Endocrinol Metab 1997; 82: 1661–7

    Article  PubMed  CAS  Google Scholar 

  90. De Pergola G, Xu X, Yang S, et al. Upregulation of androgen receptor binding in male rat fat adipose precursor cells exposed to testosterone: study in a whole cell assay system. J Steroid Biochem Mol Biol 1990; 37: 553–8

    Article  PubMed  Google Scholar 

  91. Xu X, De Pergola G, Bjorntorp P. The effects of androgens on the regulation of lipolysis in adipose precursor cells. Endocrinology 1990; 126: 1229–34

    Article  PubMed  CAS  Google Scholar 

  92. US Department of Health, Education and Welfare. The prevalence study. In: Lipid Research Group. The Lipids Research Clinics population studies data book. Vol. 1. Bethesda (MD): US Department of Health, Education and Welfare, 1979. NIH publication no: 79-1527

    Google Scholar 

  93. Heiss G, Johnson NJ, Reiland S, et al. The epidemiology of plasma high density lipoproteins cholesterol levels. Circulation 1980; 62Suppl. 4: 116

    Google Scholar 

  94. Bagatell CJ, Bremner WJ. Androgen and progestagen effects on plasma lipids. Prog Cardiovasc Dis 1995; 38: 255–71

    Article  PubMed  CAS  Google Scholar 

  95. von Eckardstein A, Kliesch S, Nieschlag E, et al. Suppression of endogenous testosterone in young men increases serum levels of high density lipoprotein subclass lipoprotein A-1 and lipoprotein(a). J Clin Endocrinol Metab 1997; 82: 3367–72

    Article  Google Scholar 

  96. Hauner H, Stangl K, Burger K, et al. Sex hormone concentrations in men with angiographically assessed coronary artery disease: relationship to obesity and body fat distribution. Klin Wochenschr 1991; 69(14): 664–8

    Article  PubMed  CAS  Google Scholar 

  97. Barrett-Connor EL. Testosterone and risk factors for cardiovascular disease in men. Diabete Metab 1995; 21(3): 156–61

    PubMed  CAS  Google Scholar 

  98. Dai WS, Gutai JP, Kuller LH, et al. Relation between plasma high-density lipoprotein cholesterol and sex hormone concentrations in men. Am J Cardiol 1984; 53(9): 1259–63

    Article  PubMed  CAS  Google Scholar 

  99. Zmuda JM, Cauley JA, Kriska A, et al. Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men: a 13-year follow-up of former Multiple Risk Factor Intervention Trial participants. Am J Epidemiol 1997; 146(8): 609–17

    Article  PubMed  CAS  Google Scholar 

  100. Zhao Sp, Li XP. The association of low plasma testosterone level with coronary artery disease in Chinese men. Int J Cardiol 1998; 63(2): 161–4

    Article  PubMed  CAS  Google Scholar 

  101. Barrett-Connor E. Lower endogenous androgen levels and dyslipidemia in men with non-insulin-dependent diabetes mellitus. Ann Intern Med 1992; 117(10): 807–11

    PubMed  CAS  Google Scholar 

  102. Khaw KT, Barrett-Connor E. Endogenous sex hormones, high density lipoprotein cholesterol, and other lipoprotein fractions in men. Arterioscler Thromb 1991; 11(3): 489–94

    Article  PubMed  CAS  Google Scholar 

  103. Freedman DS, O’Brian TR, Flanders WD, et al. Relation of serum testosterone levels to high density lipoprotein cholesterol and other characteristics in men. Arterioscler Thromb 1991; 11(2): 307–15

    Article  PubMed  CAS  Google Scholar 

  104. Arver S, Dobs AS, Meikle AW, et al. Long-term efficacy and safety of a permeation-enhanced testosterone transdermal system in hypogonadal men. Clin Endocrinol 1997; 47: 727–37

    Article  CAS  Google Scholar 

  105. Ellvin FM, Plunkett-Reid K, Rumilla AE. The long-term beneficial effect of low-dose testosterone in the aging male [abstract]. Proceedings of the 79th Annual Meeting of the Endocrine Society: 1997 Jun 11–14; Minneapolis, 236

  106. Zgliczynski S, Ossowski M, Slowinska-Srzednicka J, et al. Effect of testosterone replacement therapy on lipids and lipoproteins in hypogonadal and elderly men. Arteriosclerosis 1996; 121(1): 35–43

    Article  CAS  Google Scholar 

  107. Gardner FH, Besa EC. Physiologic mechanisms and the hematopoeitic effects of the androstanes and their derivatives. Curr Top Hematol 1983; 4: 123–95

    PubMed  CAS  Google Scholar 

  108. Krabbe S, Christensen T, Worm J, et al. Relationship between haemoglobin and serum testosterone in normal children and adolescents and in boys with delayed puberty. Acta Paediatr Scand 1978; 67: 655–8

    Article  PubMed  CAS  Google Scholar 

  109. Vahlquist B. The cause of the sexual differences in erythrocyte, hemoglobin and serum iron levels in human adults. Blood 1950; 5: 874–5

    PubMed  CAS  Google Scholar 

  110. Williamson CS. Influence of age and sex on hemoglobin: a spectrophotometric analysis of nine hundred and nineteen cases. Arch Intern Med 1916; 18: 505–28

    Article  CAS  Google Scholar 

  111. McCullagh EP, Jones R. Effect of androgens on blood counts of men. J Clin Endocrinol 1942; 2: 243–51

    Article  CAS  Google Scholar 

  112. Hamilton JB, Bunch LD, Mestler GE, et al. Effect of castration in men upon blood sedimentation rate, hematocrit and hemoglobin. J Clin Endocrinol Metab 1964; 24: 506–11

    Article  PubMed  CAS  Google Scholar 

  113. Garry PJ, Goodwin JS, Hunt WC. Iron status and anemia in the elderly: new findings and a review of previous studies. J Am Geriatr Soc 1983; 31: 389–99

    PubMed  CAS  Google Scholar 

  114. Kennedy BJ, Gilbertsen AS. Increased erythropoiesis induced by androgenic hormone therapy. N Engl J Med 1957; 256: 719–26

    Article  PubMed  CAS  Google Scholar 

  115. Krauss DJ, Taub HA, Lantinga LJ, et al. Risks of blood volume changes in hypogonadal men treated with testosterone enanthate for erectile impotence. J Urol 1991; 146: 1566–70

    PubMed  CAS  Google Scholar 

  116. Drinka PJ, Jochen AL, Cuisinier M, et al. Polycythemia as a complication of testosterone replacement therapy in nursing home men with low testosterone levels. J Am Geriatr Soc 1995; 43: 899–901

    PubMed  CAS  Google Scholar 

  117. Bhasin S, Bagatell CJ, Bremner WJ, et al. Issues in testosterone replacement in older men. J Clin Endocrinol Metab 1998; 83: 3435–48

    Article  PubMed  CAS  Google Scholar 

  118. Morley JE, Kaiser FE. Sexual function with advancing age. Med Clin North Am 1989; 73: 1483–95

    PubMed  CAS  Google Scholar 

  119. Bhasin S. Androgen treatment of hypogonadal men. J Clin Endocrinol Metab 1992; 74: 1221–5

    Article  PubMed  CAS  Google Scholar 

  120. Davidson JM, Chen JJ, Crapo L, et al. Hormonal changes and sexual function in aging men. J Clin Endocrinol Metab 1983; 57: 71–7

    Article  PubMed  CAS  Google Scholar 

  121. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychological correlates: results of the Massachussetts Male Aging Study. J Urol 1994; 151: 54–61

    PubMed  CAS  Google Scholar 

  122. Bancroft J, Wu FCW. Changes in erectile responsiveness during androgen replacement therapy. Arch Sex Behav 1983; 12: 59–66

    Article  PubMed  CAS  Google Scholar 

  123. Davidson JM, Camargo CA, Smith ER. Effects of androgen on sexual behavior in hypogonadal men. J Clin Endocrinol Metab 1979; 48: 955–8

    Article  PubMed  CAS  Google Scholar 

  124. Kwan M, Greenleaf WJ, Mann J, et al. The nature of androgen action on male sexuality: a combined laboratory-self report study in hypogonadal men. J Clin Endocrinol Metab 1983; 57: 557–62

    Article  PubMed  CAS  Google Scholar 

  125. Carani C, Bancroft J, Granata A, et al. Testosterone and erectile function, nocturnal penile tumescence and rigidity, and erectile response to visual erotic stimuli in hypogonadal and eugonadal men. Psychoneuroendocrinology 1992; 17(6): 647–54

    Article  PubMed  CAS  Google Scholar 

  126. Clopper RR, Voorhess ML, MacGillivray MH, et al. Psycho-sexual behavior in hypopituitary men: a controlled comparison of gonadotropin and testosterone replacement. Psychoneuroendocrinology 1993; 18(2): 149–61

    Article  PubMed  CAS  Google Scholar 

  127. Salmimies P, Kockott G, Pirke KM. Effects of testosterone replacement on sexual behavior in hypogonadal men. Arch Sex Behav 1982; 11(4): 345–53

    Article  PubMed  CAS  Google Scholar 

  128. Arver S, Dobs AS, Meikle AW, et al. Improvement of sexual function in testosterone deficient men treated for one year with a permeation enhanced testosterone transdermal system. J Urol 1996; 155: 1604–8

    Article  PubMed  CAS  Google Scholar 

  129. Morales A, Johnston B, Heaton JPW, et al. Testosterone supplementation for hypogonadal impotence: assessment of biochemical measures and therapeutic outcomes. J Urol 1997; 157: 849–54

    Article  PubMed  CAS  Google Scholar 

  130. Burris AS, Banks SM, Carter CS, et al. A long term, prospective study of the physiologic and behavioral effects of hormone replacement in untreated hypogonadal men. J Androl 1992; 13: 297–304

    PubMed  CAS  Google Scholar 

  131. Nielson J, Pelsen B, Sorensen K. Follow-up of 30 Klinefelter males treated with testosterone. Clin Genet 1988; 33: 262–9

    Article  Google Scholar 

  132. O’Carroll R, Shapiro C, Bancroft J. Androgens, behavior and nocturnal erection in hypogonadal men: the effects of varying the replacement dose. Clin Endocrinol 1985; 23: 527–38

    Article  Google Scholar 

  133. Albeaux-Fernet M, Bohler CC, Karpas AE. Testicular function in the aging male. In: Greenblatt RB, editor. Aging-geriatric endocrinology. Vol 5. New York: Raven Press, 1978: 210

    Google Scholar 

  134. Benton AL, Eslinger PJ, Danasio AR. Normative observations on neuropsychological test performance in old age. J Clin Neuropsychol 1981; 3: 33–42

    Article  PubMed  CAS  Google Scholar 

  135. Koss E, Haxby JW, DeCarli C, et al. Patterns of performance preservation and loss in healthy aging. Dev Psychol 1991; 7: 99–107

    Google Scholar 

  136. Janowsky JS, Oviatt SK, Carpenter JS, et al. Testosterone administration enhances spatial cognition in older men [abstract no. 340.12]. Programs and Abstracts of the Society for Neuroscience Annual Meeting; 1991 Nov: 868

  137. Vogel W, Klaiber EL, Broverman DM. The role of the gonadal steroid hormones in psychiatric depression in men and women. Prog Neuropsychopharmacol 1978; 2: 487–90

    Article  Google Scholar 

  138. Schiavi RC, White D, Mandeli J, et al. Effect of testosterone administration on sexual behaviour and mood in men with erectile dysfunction. Arch Sex Behav 1997; 26(3): 231–41

    Article  PubMed  CAS  Google Scholar 

  139. Block AJ, Boysen PG, Wynne JW, et al. Sleep apnea, hypopnea and oxygen desaturation in normal subjects: a strong male predominance. N Engl J Med 1979; 300: 513–7

    Article  PubMed  CAS  Google Scholar 

  140. Block AJ, Wynne JW, Boysen PG. Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women. Am J Med 1980; 69: 75–9

    Article  PubMed  CAS  Google Scholar 

  141. Matsumoto AM, Sandblom RE, Schoene RB, et al. Testosterone replacement in hypogonadal men: effects on obstructive sleep apnoea, respiratory drives, and sleep. Clin Endocrinol 1985; 22(6): 713–21

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Johns Hopkins University, 1830 Monument Street, Suite-328, Baltimore, Maryland, 21287, USA

    Shehzad Basaria &  Adrian S. Dobs

Authors
  1. Shehzad Basaria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adrian S. Dobs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrian S. Dobs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Basaria, S., Dobs, A.S. Risks Versus Benefits of Testosterone Therapy in Elderly Men. Drugs Aging 15, 131–142 (1999). https://doi.org/10.2165/00002512-199915020-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199915020-00006

Keywords

Search

Navigation