Aging and sex hormones in males

Area of Science:

• Endocrinology
• Geriatrics
• Men's Health

Background:

• Aging is associated with significant changes in male sex hormones, including total and free testosterone.
• Sex hormone-binding globulin (SHBG) levels often increase with age, impacting testosterone availability.
• Gonadotropin levels may vary, and comorbidities like obesity contribute to hormonal alterations in older men.

Purpose of the Study:

• To review the hormonal changes in elderly men and their clinical significance.
• To discuss the diagnostic criteria and challenges of late-onset hypogonadism (LOH).
• To explore the complexities in managing LOH, particularly regarding testosterone replacement therapy.

Main Methods:

• Review of large cohort studies over the past two decades.
• Analysis of changes in total testosterone, free testosterone, SHBG, and gonadotropins with aging.
• Examination of the role of comorbidities in influencing sex hormone levels and LOH diagnosis.

Main Results:

• Aging leads to decreased total testosterone and a steeper decline in free testosterone.
• Increased SHBG and variable gonadotropin levels are common in older men.
• Testosterone deficiency alone is insufficient for diagnosing hypogonadism; symptoms are crucial.

Conclusions:

• Late-onset hypogonadism (LOH) is defined by low testosterone levels plus associated symptoms.
• The heterogeneity of LOH, influenced by multiple factors and comorbidities, complicates diagnosis.
• Decisions regarding testosterone replacement therapy for LOH remain challenging due to these complexities.