[Androgen therapy from the viewpoint of the internal medicine physician]

The partial androgen deficit of the ageing male is an essential part of the age-related changes of the endocrine system. Clinically relevant disturbances (co-) caused by a relative testosterone-deficit are: changes of body composition (increase of fat mass, decrease of lean tissue mass), decrease of muscle strength and mass, changes of the lipid profile, cardiovascular disease, osteoporosis and anemia. Controlled studies revealed a positive effect of testosterone substitution on body composition, muscle strength, bone metabolism and erythropoesis. Moreover, a protective effect on the development of coronary artery disease could be demonstrated by an improvement of the lipid profile, decrease of obesity and insulin resistance and by a direct effect on the coronary vessels. Clinically evident hypogonadism is a clear indication for testosterone-substitution also in the ageing male, whereas in the case of the partial testosterone-deficit in the absence of sufficient data at this time no general recommendation for substitution can be given; one has to decide about a (experimental) therapy in the individual patient. In every case the contraindications of a testosterone-supplementation (carcinoma of the prostate, elevated PSA-values, polyglobulia, sleep-apnea-syndrome) have to be observed, a continuous survey of the therapy, especially of the prostate is essential. A general recommendation for a substitution with dehydroepiandrosterone (DHEA) can not be given.