Testosterone deficiency: myth, facts, and controversy

Area of Science:

• Endocrinology
• Men's Health
• Geriatrics

Background:

• Testosterone deficiency (TD) affects ~30% of men aged 40-79, increasing with age and conditions like obesity, diabetes, and hypertension.
• TD is linked to metabolic syndrome, with potential benefits of testosterone repletion on comorbidities.
• Emerging evidence suggests testosterone's role beyond sexual health, impacting metabolic health, body composition, and all-cause mortality.

Purpose of the Study:

• To review the current understanding of testosterone deficiency (TD) in aging men.
• To discuss the potential benefits and risks of testosterone repletion therapy.
• To provide practical recommendations for diagnosing and managing TD in middle-aged and older men.

Main Methods:

• Review of recent guidelines and studies on testosterone deficiency prevalence and treatment.
• Analysis of clinical trials and retrospective studies examining cardiovascular risks associated with testosterone repletion.
• Examination of diagnostic criteria and treatment modalities for TD.

Main Results:

• Testosterone repletion may offer benefits for metabolic health and body composition in deficient men.
• Conflicting evidence exists regarding cardiovascular risks, with some studies suggesting increased risk in older men and those with heart disease.
• Guidelines and applications of testosterone repletion are expanding, necessitating careful patient selection.

Conclusions:

• Testosterone deficiency is prevalent in aging men and associated with metabolic syndrome.
• Testosterone repletion shows potential benefits but requires careful consideration of cardiovascular risks, especially in older or comorbid populations.
• Accurate diagnosis and individualized treatment strategies are crucial for managing testosterone deficiency in middle-aged and older men.