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Updated: Jul 13, 2025

Combining Behavioral Endocrinology and Experimental Economics: Testosterone and Social Decision Making
Published on: March 2, 2011
EMAS position statement: Testosterone replacement therapy in older men.
George A Kanakis1, Riccardo Pofi2, Dimitrios G Goulis3
1Department of Endocrinology & IVF Unit, Athens Naval and Veteran Affairs Hospital, Athens, Greece.
Testosterone replacement therapy (TRT) is recommended for symptomatic older men with confirmed low testosterone, balancing benefits against uncertain long-term safety. TRT may improve sexual function, insulin resistance, and quality of life in select cases.
Area of Science:
- Geriatric Medicine
- Endocrinology
- Men's Health
Background:
- Late-onset hypogonadism (LOH) in aging men presents with low testosterone and symptoms, linked to metabolic syndrome, reduced bone density, and cardiovascular risks.
- While testosterone replacement therapy (TRT) benefits younger men, its risk/benefit profile in older men remains debated.
Purpose of the Study:
- To provide an updated evidence-based statement on the use of TRT in older men with LOH.
- To incorporate recent research findings into clinical recommendations.
Main Methods:
- Comprehensive literature review of recent studies on LOH and TRT.
- Consensus development based on expert opinion.
Main Results:
- TRT is advised for symptomatic older men with confirmed low testosterone, with careful consideration of long-term safety uncertainties.
- TRT may benefit specific conditions like erectile dysfunction, severe insulin resistance, osteoporosis, and depressive symptoms.
- TRT is contraindicated in men seeking fertility, with active cancer, recent cardiovascular events, or severe heart failure.
Conclusions:
- TRT decisions for older men must be individualized, weighing perceived benefits against risks.
- Monitoring of testosterone levels, haematocrit, PSA, and clinical response is crucial.
- Lifestyle modifications are essential for obese/overweight men to enhance endogenous testosterone.
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