Testosterone and the Older Man

Abstract

Although sex hormone replacement therapy (HRT) for postmenopausal women has been a standard practice for many years, the idea that an older man might be sex hormone deficient and might benefit from placement therapy has gained significant medical interest only within the past 10–15 years. The first modern era studies of male HRT were reported about a decade ago (1,2), and there are, as yet, no large multicenter randomized placebo controlled trials of male HRT. In addition, there currently is no agreement on what hormonal or clinical criteria should be used to decide which older men might be considered “androgen deficient” and candidates for HRT. The lack of consensus, however, has not lessened the public and media interest in this topic. Testosterone sales, at least in the United States, continue to increase. At the same time, how to identify [partial]androgen deficiency of the aging male (PADAM), and the utility of androgen supplementation for older men continue to be vigorously investigated. The potential interest in male HRT for PADAM is based on two major factors: There is a decline in serum testosterone levels as men age and there are concomitant changes in androgen target organs that are reminiscent of what is seen in hypogonadal young adult men before they receive testosterone replacement.