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Testosterone supplementation therapy for older men: potential benefits and risks.
David A Gruenewald1, Alvin M Matsumoto
1Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, and Department of Medicine, University of Washington School of Medicine, Seattle, 98108, USA. david.gruenwald@med.va.gov
Journal of the American Geriatrics Society
|January 22, 2003
Summary
Testosterone supplementation may benefit older men with low levels, improving body composition and function. However, it
Area of Science:
- Gerontology and Endocrinology
- Men's Health Research
Background:
- Serum testosterone levels naturally decline with age in men.
- Age-related testosterone decline shares symptoms with hypogonadism, suggesting potential benefits of supplementation.
- Existing research indicates testosterone therapy may mitigate aging effects.
Purpose of the Study:
- To review placebo-controlled trials on testosterone supplementation in men aged 60 and older.
- To evaluate the impact of testosterone therapy on physical, cognitive, affective, functional, and quality-of-life outcomes.
- To determine evidence-based indications for testosterone supplementation in aging men.
Main Methods:
- Performed a MEDLINE search for relevant studies.
- Conducted a qualitative review of placebo-controlled trials in men aged 60+.
- Excluded studies on severe systemic diseases or specific hormone deficiencies.
Main Results:
- Testosterone therapy increased lean mass and decreased fat mass in healthy older men with low-normal testosterone.
- Improvements were observed in strength, functional performance, sexual function, and mood.
- Cognitive function showed variable effects, with some domains improving; coronary ischemia also improved.
- Men with markedly low testosterone levels showed greater benefits in bone density, function, libido, and cardiac health.
- Hematocrit and prostate-specific antigen levels often increased, with no major adverse lipid effects.
Conclusions:
- Testosterone supplementation is not recommended for older men with normal or low-normal testosterone levels without hypogonadism symptoms.
- Therapy may be warranted for older men with markedly decreased testosterone levels or mild deficiency with symptoms.
- Long-term safety and efficacy require further investigation through rigorous clinical trials.