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The ageing male
1Department of Urology, Erasme Hospital University, Brussels, Belgium. claude.schulman@ulb.ac.be
Insights
Aging men experience hormone deficiencies, impacting urological health and mood. Testosterone replacement therapy can help, but requires careful monitoring and its link to prostate cancer remains undetermined.
Area of Science:
- Endocrinology
- Urology
- Gerontology
Background:
- Prolonged life expectancy leads to extended periods of hormone deficiency for both men and women.
- Aging males face increased risks of urological issues like benign prostatic hyperplasia (BPH), prostate cancer, incontinence, and erectile dysfunction.
- Distinguishing natural aging from illness-induced hormonal changes is complex.
Purpose of the Study:
- To review hormonal changes in aging males.
- To discuss associated health issues and available testosterone replacement therapies.
- To outline monitoring guidelines for testosterone therapy.
Main Methods:
- Review of literature on male aging, hormone levels, and associated conditions.
- Analysis of hormonal changes including testosterone, DHEA, growth hormone, and gonadotropins.
- Examination of the effects of hormonal changes on body composition, bone health, sleep, and mood.
Main Results:
- Aging males exhibit decreased testosterone, DHEA, growth hormone, and melatonin, with increased LH and FSH.
- Increased sex hormone-binding globulin (SHBG) further reduces free, biologically active testosterone.
- Hormonal shifts correlate with changes in body mass index, osteoporosis, sleep disturbances, and mood disorders.
Conclusions:
- Testosterone replacement therapies aim to restore physiological hormone levels, including metabolites like DHT and estradiol.
- Monitoring of men on testosterone therapy is recommended at 3-month intervals initially, then annually.
- The relationship between testosterone replacement and prostate cancer development requires further investigation.
Abstract:
With prolonged life expectancy, men and women can expect to live one-third of their lives with some form of hormone deficiency. The ageing male, in particular, has the added problem of developing urological diseases, such as benign prostatic hyperplasia (BPH), prostate cancer, continence disorders and erectile dysfunction. When discussing age-related problems, it is often difficult to separate and to distinguish between the natural ageing process, ageing amplifiers and an acute or chronic illness, or inter-current diseases. Partial endocrine deficiencies of ageing are associated with a decrease in the peripheral levels of testosterone, dehydroepiandrosterone (DHEA), DHEA sulphate (DHEA-S), growth hormone, insulin-like growth factor and melatonin. There is also a concomitant increase in luteinising hormone and follicle stimulating hormone. The concentration of free biologically active testosterone is lowered further by an increase in sex hormone binding globulin (SHBG). Hormonal changes in the ageing male are associated with changes in the body mass index, osteoporosis, sleep and mood disorders. A number of testosterone replacement therapies are available. These therapies should maintain physiological levels not only of serum testosterone, but also of its metabolites, including dihydrotestosterone (DHT) and estradiol. Men on testosterone therapy should be monitored at 3-month intervals during the first year of use and, thereafter, at 1-year intervals if they are stable. The association of testosterone replacement with development of prostate cancer has not been determined.