Androgen deficiency (AD) affects 1 in 200 men under 60 years. Symptoms and signs may be subtle or non-specific and many cases remain undiagnosed. When identified by clinical features and confirmatory endocrine testing, AD requires treatment irrespective of age. Primary testicular disease (low testosterone [T], high LH) may present with infertility so that co-existent AD must be considered in that setting. Klinefelter’s syndrome (47XXY) is the commonest cause of AD yet 70% of cases remain undiagnosed. Secondary AD (low T, low LH) results from hypothalamo-pituitary disorders and be accompanied by other The total T level is the key clinical measure; the timing and number of samples, the assay method and reference interval effect its interpretation. hormone deficiencies.Testosterone therapy (TRx) is effective in restoring normal sexual, bone and muscle health, and quality of life (QOL), and potentially in normalising cardiovascular risk. The definition and prevalence of AD in association with ageing per se is contentious. Concomitant illness, particularly obesity, may confound evaluation as it is associated with lower serum T levels and similar symptoms. Placebo-controlled RCTs of TRx in older men show only modest improvement in body composition, inconsistent effects on physical function and QOL, and all lack long term safety data. Transdermal systems, crystalline T implants and injectable T ester formulations acceptable serum profiles. Absolute and relative contraindications are recognised. Age-appropriate health monitoring is required but with attention to polycythemia, sleep disturbance, and monitoring of prevalent diseases in older men such as prostate and cardiovascular disease. Current studies are exploring the utility of TRx in metabolic syndrome, ‘PDE5 refractory’ erectile dysfunction with low-normal T levels, and as an anabolic agent to improve nutrition, strength & function in chronic wasting diseases. Finally TRx is a core component of male hormonal contraception undergoing clinical trials.
Conflict of Interest: None disclosed
Financial Support/Funding: None disclosed
Recorded: Sydney, Australia, April 2007
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