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Androgen deficiency in older men.

Mathis Grossmann¹

¹MD, PhD, FRACP, Professor of Medicine, Department of Medicine, Austin Health, University of Melbourne; Head of Men@s Health, Department of Endocrinology, Austin Health, Melbourne, Vic. mathisg@unimelb.edu.au.

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|July 1, 2019

Summary

Older men with low energy and sexual dysfunction often have functional testosterone deficiency. Lifestyle changes like weight loss are the first step, with testosterone therapy reserved for specific cases pending further research.

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Area of Science:

Endocrinology
Men's Health
Geriatrics

Background:

Older men, particularly those who are overweight or obese with comorbidities, frequently exhibit symptoms suggestive of androgen deficiency.
These non-specific symptoms include fatigue, sexual dysfunction, and mildly reduced serum testosterone levels compared to younger, healthier men.

Purpose of the Study:

To outline the clinical management strategy for men presenting with symptoms mimicking androgen deficiency.

Main Methods:

Review of clinical presentations and diagnostic considerations for non-specific androgen deficiency-like symptoms in older men.
Emphasis on differentiating functional gonadal axis suppression from organic hypogonadism.

Main Results:

The majority of men with these symptoms experience functional suppression due to underlying health issues, not primary pituitary or testicular disease.
Lifestyle interventions such as weight loss, managing comorbidities, and discontinuing certain medications can improve symptoms and testosterone levels.
Recent trials show modest benefits of testosterone therapy in select older men, but long-term risks and benefits remain largely unknown.

Conclusions:

Lifestyle modifications should be the primary treatment approach for functional gonadal axis suppression.
Testosterone replacement therapy is not routinely recommended for non-specific symptoms outside of established organic hypogonadism.
Further research is essential to determine the long-term safety and efficacy of testosterone treatment in older men.