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David Freedman Medicine Professional Corporation

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Men: Testosterone Levels and "Andropause"

As men age, their serum free testosterone levels decrease. This may be associated with several changes in the body and may be referred to as andropause or testosterone deficiency syndrome. 

The decline of serum testosterone is usually modest and the body appears to gradually change with it. It is not yet known whether or not testosterone therapy should be administered to older asymptomatic men in an effort to attempt to reverse these changes.

Traditionally, the administration of testosterone therapy is considered in younger men who are hypogonadal as defined by the presence of abnormal symptoms and physical signs in the setting of a low testosterone level. The goal in these patients is to restore the testosterone level to the normal range and to improve their symptoms.  When younger hypogonadal menare treated with testosterone, the abnormal changes appear to improve. In the absence of known hypogonadism, the decision of whether or not to treat a man with a low testosterone level needs to be individualized. Consultation with an expert who specializes in this field is strongly encouraged.

So, Why might we desire to treat older asymptomatic men who have a low testosterone level?  

Studies of aging men observe a possible association between lower testosterone levels and many types of problems including but not limited to:

  • reduced sexual function (erectile dysfunction)

  • decreased libido

  • lower bone mineral density

  • reduced muscle mass

  • reduced muscle strength.

  • increased fat mass.

  • Depressive symptoms.

  • Poor "mood"

  • weak and tired  

  • higher CRP levels ( a marker of vascular risk)

  • central obesity

  • metabolic syndrome 

  • higher insulin resistance

  • diabetes

  • increased aortic and carotid atherosclerosis

  • worse prognosis in heart failure patients

  • increased death rate

 

These studies suggest that the drop in serum testosterone levels may be the cause of these age-related changes.

Some studies suggest a benefit of administrating testosterone therapy  as associated with:

  • reduced angina

  • increased ischemia threshold

  • increased coronary blood flow

  • reduced inflammatory markers, increased anti-inflammatory markers

  • improved functional capacity in patients with heart failure

 

However, there may be  some potential risks as well  with this intervention including but not limited to:

  • increased sleep apnea

  • increased blood cell count

  • fluid retention

  • uncertainty as to whether or not giving testosterone may affect diseases of the prostate

  • possible increased cardiovascular risk.                                                                                                                   

  • There are some studies to date suggesting that there is no increase in cardiovascular risk. But, there is also some study evidence suggesting a possible increase in cardiovascular risk. The reason for these different conclusions is not yet clear and further investigation may be considered.

 

Unfortunately, studies to date are limited and do not support administrating testosterone therapy to older asymptomatic patients purely on the basis of a low serum testosterone.

Physician groups who are actively involved in treating patients with low serum testosterone argue that there may be a role in selected symptomatic  patients.

 

As with all therapeutic interventions, the risks/benefits must be reviewed with your doctor.