Testosterone supplementation in the aging male: which questions have been answered?

There is no consensus on possible benefits and risks of testosterone supplementation. Here we review various controlled studies of testosterone supplementation in aging males.

We performed a PubMed search using the terms "testosterone/therapeutic use" with the limits " > 65 years of age", "randomized controlled clinical trials", and "male gender", starting in 1999.

Forty-three articles have been published since 1999. Some of these studies also included patients in middle-age or younger. Findings reported in these articles were not entirely consistent. After weighting studies by the number of patients, hints are found that testosterone supplementation increases bone mass, lean body mass, muscle mass and hematopoiesis, and improves sexual functioning and perhaps mood, but does not affect serum lipids, cardiovascular parameters, prostate-specific antigen level, or cognition. Considering studies including only men older than 65 years, and in which testosterone supplements were compared with placebo treatment, slightly different results are obtained. In these patient groups, testosterone does not improve sexual function or mood.

The overall benefit of testosterone supplementation for the aging male remains unclear. Any supplementation in men with age-normal testosterone levels only on grounds of subjective symptoms is not advisable.