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11: Androgen deficiency and replacement therapy in men
David J Handelsman1, Jeffrey D Zajac
1ANZAC Research Institute, Concord Hospital, Sydney, NSW. djh@anzac.edu.au
The Medical Journal of Australia
|May 14, 2004
Summary
Androgen deficiency requires hormone testing for diagnosis. Treatment involves lifelong hormone replacement therapy after confirmed deficiency, with careful monitoring, especially in older men.
Area of Science:
- Endocrinology
- Men's Health
- Hormone Therapy
Background:
- Androgen deficiency is a clinical diagnosis confirmed by hormone assays.
- In younger men, it often stems from hypothalamopituitary or testicular issues.
- Diagnosis in older men is challenging due to non-specific symptoms and age-related testosterone decline.
Purpose of the Study:
- To outline the diagnostic criteria and management of androgen deficiency.
- To differentiate causes in younger versus older men.
- To assess the role of androgen replacement therapy (ART) in different age groups.
Main Methods:
- Clinical diagnosis based on hormone assays.
- Evaluation of patients presenting with erectile dysfunction.
- Review of evidence for ART efficacy and safety in various populations.
Main Results:
- Androgen deficiency requires confirmed hormone assays for diagnosis.
- Erectile dysfunction is an uncommon symptom of androgen deficiency.
- Lifelong ART is indicated after confirmed deficiency, with ongoing monitoring.
- Evidence for ART effectiveness and safety in older men without overt deficiency is lacking.
Conclusions:
- Androgen deficiency diagnosis requires objective hormone measurement.
- Androgen replacement therapy should be lifelong post-diagnosis with monitoring.
- Caution is advised regarding ART in older men unless frank deficiency is present.
- Further investigation is needed for underlying disorders when overt deficiency is confirmed.