Search

The objective of this study was to characterise the status of health-related quality of life ( HRQOL) in Japanese men with late-onset hypogonadism ( LOH) treated with testosterone replacement therapy ( TRT). HRQOL in 69 consecutive Japanese men with LOH undergoing TRT for at least 6 months was prospectively evaluated before and 6 months after the initiation of TRT using the Medical Outcomes Study 8-Item Short-Form Health Survey ( SF-8). All eight-scale scores except for bodily pain ( BP) in the 69 patients at 6 months after the introduction of TRT significantly improved compared with those before TRT; however, all scale scores except for BP in the 69 patients were significantly inferior to those in age-matched Japanese controls irrespective of the timing of SF-8. Multivariate analyses of several parameters revealed that both age and Aging Male Symptom ( AMS) score had an independent impact on mental health ( MH), despite the lack of an independent association between any score and the remaining factors examined. TRT appeared to significantly improve the status of HRQOL in men with LOH; however, even after the introduction of TRT, HRQOL associated with MH remained significantly impaired in elderly men and/or those with a high AMS score. [ABSTRACT FROM AUTHOR]

Objectives To test the hypothesis that testosterone replacement therapy (TRT) improves the long-term health-related quality of life (HRQoL) of men with late-onset hypogonadism (LOH), as studies have shown that sub-physiological testosterone levels have a negative impact on psychological (e.g. mood, vitality, libido and sexual interest) and physical features (e.g. erectile function and physical strength), all of which contribute to a sense of well-being. Patients and methods In all, 261 patients (mean age 58 years) diagnosed with LOH were treated with long-acting intramuscular testosterone undecanoate (TU) for up to 5 years. Health quality indicators including the International Prostate Symptom Score (IPSS), the five-item version of the International Index of Erectile Function (IIEF-5), the Aging Males’ Symptoms (AMS) scale, and the percentage of patients reporting joint and muscle pain were measured at baseline and at each visit. The means were then plotted over time in parallel with mean total testosterone (TT) levels. Results Both the mean IPSS and AMS scores fell significantly within the first 3 months and the mean IIEF-5 score and TT levels increased within the first 3 months. All four parameters continued to improve over the course of the trial. The percentage of patients reporting both joint and muscle pain decreased during TRT. Conclusions This prospective, observational and longitudinal analysis shows a clear improvement in both psychological and physical characteristics as physiological testosterone levels are reached and maintained contributing to an improvement in the HRQoL in men with diagnosed LOH. [ABSTRACT FROM AUTHOR]

Introduction: Late-onset hypogonadism (LOH) represents a common clinical entity in aging males, characterized by the presence of symptoms (most usually of a sexual nature, such as decreased libido, decreased spontaneous erections and erectile dysfunction) and signs, in combination with low serum testosterone concentrations. Whether testosterone replacement therapy (TRT) should be offered to those individuals is still under extensive debate.Aims: The aim of this position statement is to provide and critically appraise evidence on TRT in the aging male, focusing on pathophysiology and characteristics of LOH, indications for TRT, available therapeutic agents, monitoring and treatment-associated risks.Materials and Methods: Literature review and consensus of expert opinion.Results and Conclusions: Diagnosis and treatment of LOH is justified, if a combination of symptoms of testosterone deficiency and low testosterone is present. Patients receiving TRT could profit with regard to obesity, metabolic syndrome, type 2 diabetes mellitus, sexual function and osteoporosis and should undergo scheduled testing for adverse events regularly. Potential adverse effects of TRT on cardiovascular disease, prostate cancer and sleep apnea are as yet unclear and remain to be investigated in large-scale prospective studies. Management of aging men with LOH should include individual evaluation of co-morbidities and careful risk versus benefit assessment. [ABSTRACT FROM AUTHOR]

The late-onset hypogonadism is defined as a reduction of blood testosterone values in aging males in combination with sexual symptoms. A hormone substitution is only necessary if desired by the patient. Erectile dysfunction is often caused by vasculopat hy. Therefore, vascular risk factors should be evaluated. In case of cardiovascular disease a cardiologist should be addressed before initiating treatment. First line therapy consists of phosphodiesterase inhibitors. In lower urinary tract symptoms prostatic enlargement is the likely cause, but other causes have to be ruled out. Symptomatic therapy can be initiated if the patient is bothered. If voiding symptoms are predominant, alpha blockers or alpha reductase inhibitors are the treatment of choice. In case of storage symptoms, treatment can be started with muscarin receptor antagonists. [ABSTRACT FROM AUTHOR]

Low testosterone is associated with late-onset hypogonadism ( LOH) and obesity. Recently, studies have shown that four single nucleotide polymorphisms ( SNPs), rs12150660, rs727428, rs5934505, and rs10822184, are associated with testosterone levels in populations of European descent. Therefore, we investigated whether the SNP loci are related to low testosterone, LOH, or obesity in a Chinese Han population. Ruling out co-morbidities, DNA was prepared from 409 men (aged 40-65 years) with low serum testosterone (defined as total testosterone <11.6 nmol/L) and 1 : 1 normal controls (matched age, body mass index ( BMI), and the same living area) who were selected from 6898 males. According to the same standards, 310 men with LOH and 1 : 1 normal controls were selected from 6898 males. Excluding the cases with an unreliable sequencing result, genetic analyses were performed. The minor allele frequencies of the SNP loci rs12150660, rs727428, rs5934505, and rs10822184 were 0.1%, 44.6%, 18.7%, and 38.9%, respectively. rs5934505 was associated with the serum total testosterone and calculated free testosterone (CFT) levels ( p = 0.045 and p = 0.021). rs5934505 (C>T) was associated with an increased risk of low total testosterone, low CFT, and LOH and adjusted for other factors, with an odds ratio ( OR) of 2.01 (1.34-3.01), 2.14 (1.42-3.20), and 1.64 (1.04-2.58). rs10822184 was significantly correlated with weight and BMI ( p = 0.035 and p = 0.027). rs10822184 (T>C) was associated with an increased risk of overweight and obesity. We adjusted for other factors, with odds ratios ( ORs) of 1.94 (1.36-2.78) and 1.56 (1.00-2.43). In summary, our study provided convincing evidence that rs5934505 (C>T) was associated with the risk of low testosterone and LOH in Chinese populations. We were the first to find that rs10822184 (T>C) was significantly correlated with the risk of overweight and obesity in Chinese populations. However, further large and functional studies are warranted to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: Late-Onset Hypogonadism (LOH) is defined as a clinical and biochemical syndrome associated with advancing age. It is characterized by specific symptoms and less specific manifestations due to deficiency of serum testosterone (T) levels., Objective: This review aims to summarize the evidence related to LOH definition, diagnostic approach, and treatment to answer a clinical question: "Is Testosterone the fountain of youth for aging men?"., Methodology: MEDLINE/PubMed and institutional websites were searched for original papers, guidelines, and position statements published in the last ten years., Results: Observational and randomized controlled studies on T replacement therapy in older men have been reported., Discussion and Conclusion: Despite some heterogeneities regarding diagnostic definition, therapeutic target, and testosterone prescription, all guidelines agreed that male hypogonadism should be diagnosed and managed in aged men as in adulthood. However, trials assessing the efficacy of T therapy conducted for male rejuvenating are lacking; thus, T prescription for this purpose is not recommended., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Testosterone deficiency can occur in males of all ages. In adult males, it is induced by endogenous testosterone decline through aging and other modifiable factors. Recent publications suggested the importance of the magnitude of longitudinal decline of testosterone from baseline. The baseline level and the longitudinal decline have individual variability influenced by individual factors including digit ratio, CAG repeat of the androgen receptor and sirtuin activity. Regarding treatment for testosterone deficiency, testosterone replacement therapy is the gold standard for the management of testosterone-deficient patients, and it improves three domains of testosterone deficiency symptoms, such as the physical, psychological and sexual domain. Recent reports suggested the importance of modifiable factors in the testosterone decline in addition to aging. Therefore, it might be responsible for the prevention of testosterone deficiency symptoms to maintain testosterone secretion taking account of the modifiable factors. The present article reviews the literature, and introduces contemporary perspectives and management of testosterone deficiency. [ABSTRACT FROM AUTHOR]

Late-onset hypogonadism (LOH), defined as a combination of low serum testosterone (T) levels in combination with clinical signs and symptoms of androgen deficiency in ageing men, is nowadays a well-characterized disease. Testosterone therapy in males affected by hypogonadism leads to a significant decrease of fat mass. In humans, the exact molecular mechanism of T effects on inhibition of adipogenesis is still unknown. We hypothesized that specific microRNAs could be regulated by androgens which might cause an inhibition of adipogenic differentiation. To confirm this hypothesis, human mesenchymal stem cells and a preadipocyte cell line were differentiated into mature adipocytes and in parallel treated with testosterone and dihydrotestosterone. The expression level of miR-375 was upregulated during adipogenic differentiation and downregulated after androgen treatment. Furthermore, we could show that after androgen treatment the decreased expression of miR-375 led to increased expression levels of adiponectin receptor 2 (ADIPOR2) compared to untreated adipocytes. Moreover, inhibition of miR-375 also mediated a decreased adipogenic differentiation and increased ADIPOR2 expression levels. In summary, we identified miR-375 as an androgen regulated microRNA, which could play an important role for understanding the mechanism of the increase in visceral fat mass and the associated insulin resistance caused by testosterone deficiency. [ABSTRACT FROM AUTHOR]

Hypogonadism is a condition in which the endogenous secretion of testosterone is either insufficient or inadequate to maintain serum testosterone levels within normal range, and may manifest as a variety of signs and symptoms. Age-related hypogonadism is due to a combination of primary hypogonadism (testicular failure) and secondary hypogonadism (hypothalamic-pituitary axis failure). This review provides insight into the mechanisms resulting in the multifactorial nature of acquired androgen-deficiency, and outlines the current controversy regarding testosterone-replacement therapy in aging males. [ABSTRACT FROM AUTHOR]

Late-onset hypogonadism (LOH) is a clinical syndrome characterized with aging and declined serum testosterone levels. Sexual symptoms are also essential for the diagnosis of LOH. Testosterone replacement therapy is used widely to treat LOH. However, the side effects of it should not be ignored, such as fluid retention, hypertension and spermatogenic suppression. Therefore, alternate treatment modalities have been pursued. Herbal medicines used widely in China have achieved satisfying results with little side effects. Nonetheless, there are few pharmacological researches on them. In this study, 24-month-old mice were used as LOH animal models to explore the pharmacological effects of a herbal medicine, saikokaryukotsuboreito (SKRBT), on serum testosterone levels and sexual functions. Furthermore, the expression of steroidogenic acute regulatory (StAR) protein, a kind of rate-limiting enzyme of testosterone synthesis, was also examined. As a result, SKRBT improved the serum testosterone levels of these mice at a dose of 300 and 450 mg/kg. Multiple measures of sexual behavior were enhanced. The expression of StAR was also increased. Therefore, this study suggested that SKRBT can improve the serum testosterone levels by activating the expression of StAR and might be a viable option to treat sexual symptoms caused by LOH. [ABSTRACT FROM AUTHOR]

Androgens are essential for the development and growth of the genitalia. They regulate the erectile physiology by multiple mechanisms. Several studies have examined associations among sex hormones' serum levels, erectile function and sex drive. We sought to identify a protocol for using testosterone in men with erectile dysfunction and late-onset hypogonadism ( LOH). During a 16-month period, men with erectile dysfunction who presented to the andrology clinic were selected. They underwent a complete physical examination and filled out the International Index of Erectile Function-5 questionnaire. Serum luteinising hormone ( LH) and testosterone levels were evaluated. Patients received a single intramuscular injection of 250 mg testosterone. Thereafter, serum levels of LH and testosterone were measured 3 weeks later. The mean age was 53 years old. After treating patients with testosterone, 45 (94%) showed improvement in LOH symptoms including libido, loss of energy, irritability and quality of life. The mean International Index of Erectile Function was 9 and 13.1, prior to and after treatment respectively. Mean serum testosterone levels before and after treatment were 4.2 and 4.1 ng ml−1 respectively ( P = 0.849). Mean serum LH revealed a significant decrease after the study ( P = 0.004) (6.12 and 5.1 ng ml−1, before and after the study respectively). Our findings suggested that testosterone replacement therapy improves libido and LOH symptoms in individuals with almost normal or lower limit normal value of serum testosterone levels. [ABSTRACT FROM AUTHOR]

Introduction Androgen receptor ( AR) CAG polymorphism has been found to influence sexual function. However, no study has evaluated its potential to condition sexual function recovery after testosterone replacement therapy ( TRT) in a large cohort of hypogonadic subjects. Aim To evaluate the role of this polymorphism in sexual function improvement after TRT in late-onset hypogonadism ( LOH). Methods Seventy-three men affected by LOH were retrospectively considered. Evaluations were performed before TRT started (time 0) and before the sixth undecanoate testosterone injection. Main Outcome Measures International Index of Erectile Function ( IIEF) questionnaire (erectile function [ EF], orgasmic function [ OF], sexual desire [ SD], intercourse satisfaction [ IS], overall satisfaction [ OS], and total IIEF-15 score); total and free testosterone and estradiol; AR gene CAG repeat number. Results TRT induced a significant increase in total and free testosterone and estradiol. All IIEF domains significantly improved after TRT. AR CAG repeats negatively and significantly correlated with all the variations (Δ-) of sexual function domains, except for Δ- OS. Conversely, Δ-total testosterone was found to be positively and significantly correlated with sexual function domain variations, except for Δ- IS and Δ- OS. Δ-estradiol did not correlate significantly with any of the variations of sexual function domains. After inclusion in generalized linear models, the number of AR gene CAG triplets was found to be independently and negatively associated with Δ- EF, Δ- SD, Δ- IS, and Δ- Total IIEF-15 score, whereas Δ-total testosterone was independently and positively associated with Δ- EF, Δ- OF, Δ- SD, and Δ- Total IIEF-15 score. However, after including time 0 total testosterone in the model, AR gene CAG triplets remained independently and negatively associated only with Δ- EF and Δ- Total IIEF-15 score, whereas Δ-total testosterone was independently and positively associated only with Δ- EF. Conclusions Longer length of AR gene CAG repeat tract seems to lower TRT-induced improvement of sexual function in LOH. Tirabassi G, Corona G, Biagioli A, Buldreghini E, delli Muti N, Maggi M, and Balercia G. Influence of androgen receptor CAG polymorphism on sexual function recovery after testosterone therapy in late-onset hypogonadism. J Sex Med 2015;12:381-388. [ABSTRACT FROM AUTHOR]

Introduction The use of testosterone replacement therapy ( TRT) in men with prostate cancer is controversial given concerns of androgen-related cancer progression. Although emerging evidence suggests that TRT may be safe in this setting, no study has investigated dose-related effects. Aim We used time-varying analysis to determine whether increasing TRT exposure is associated with worse outcomes. Methods Using linked Surveillance, Epidemiology, and End Results-Medicare data, we identified 149,354 men diagnosed with prostate cancer from 1991 to 2007. Subjects treated with TRT were stratified by duration of treatment. Weighted propensity score methods were used to adjust for differences between groups. A Cox proportional hazards model was constructed to assess the effect of injectable TRT exposure on outcomes. Main Outcome Measure Overall mortality ( OM), prostate cancer-specific mortality ( PCSM), and use of salvage androgen deprivation therapy ( ADT). Results Men treated with TRT, regardless of duration, did not experience higher OM or PCSM (all hazard ratio [HR] < 1.0, all P ≤ 0.002). We found no difference in use of salvage ADT in the ≤30-day and 31-60 day groups compared with no- TRT ( HR 1.23 and 1.05, P = 0.06 and 0.81, respectively), whereas it was lower for men on long-term TRT ( HR 0.70, P = 0.04). Conclusions TRT following prostate cancer diagnosis and treatment does not increase mortality or the use of salvage ADT. Using time-varying analysis, we demonstrate that longer duration of TRT is not associated with adverse mortality or greater need for ADT. Kaplan AL, Lenis AT, Shah A, Rajfer J, and Hu JC. Testosterone replacement therapy in men with prostate cancer: A time-varying analysis. J Sex Med 2015;12:374-380. [ABSTRACT FROM AUTHOR]

The term 'male menopause' was first used in 1944 to describe various complaints of ageing men which at least partially mirrored the climacteric symptoms in women. Continuous research resulted in the evolution of opinions about the nature of these complaints, from the clinical syndrome, diagnosed with the use of disease- targeted questionnaires, to a well-defined clinical and biochemical syndrome. The pathophysiological causes - gonad ageing (with a compensatory rise in luteinizing hormone), age-related increase in serum sex hormone- binding globulin (SHBG) levels, the role of visceral adipose tissue as a place for aromatization of androgen to estrogen, and lower sensitivity of testosterone receptors - have been described. However, no consensus was reached as far as the definition, incidence, treatment, and especially testosterone therapy, are concerned. Our review presents the current standpoints, indicating the predictive role of late-onset hypogonadism (LOH) in evaluating male health as well as the current literature reports on the risks and benefits of using testosterone therapy. [ABSTRACT FROM AUTHOR]

Late-onset hypogonadism (LOH) and depression contribute to cardiovascular disease (CVD) in male hemodialysis (HD) patients. Carnitine deficiency is frequently observed in HD patients, playing a role in CVD. We examined whether carnitine deficiency was independently associated with LOH and depression in these patients. Twenty-six male HD patients underwent determinations of serum levels of free carnitine and testosterone. Status of LOH and depression were evaluated by questionnaires using aging male symptoms' (AMS) scale and self-rating depression scale (SDS), respectively. Free carnitine and testosterone levels in male HD patients were significantly lower than those in age-matched healthy male subjects. Linear regression analysis showed that AMS scale was positively associated with SDS. Univariate regression analysis revealed that total carnitine (inversely), free carnitine (inversely) and HD duration were correlated with AMS scale. Multiple stepwise regression analysis revealed that free carnitine was an independent determinant of AMS scale. Furthermore, free carnitine was also independently correlated with SDS in male HD patients. This study demonstrated that decreased free carnitine levels were independently associated with AMS scale and SDS in male HD patients. The observations suggest that decreased free carnitine levels could be a marker and therapeutic target of LOH and depression in uremic men with HD. [ABSTRACT FROM AUTHOR]

Late-onset hypogonadism (LOH) is typically defined as the cluster of symptoms appearing in aging men and accompanied by a decrease in serum testosterone levels. The identification of a simple screening tool with a high level of sensitivity and specificity to predict LOH has remained a challenge. To identify men with LOH, a variety of self-administered questionnaires have been developed including The Saint Louis University Androgen Deficiency in the Aging Male (ADAM) Questionnaire, The Quantitative ADAM (qADAM) Questionnaire, The Aging Male Symptoms (AMS) rating scale, The Massachusetts Male Aging Study (MMAS) questionnaire and The New England Research Institutes (NERI) hypogonadism questionnaire. The applicability of these questionnaires in the clinical setting is debated because some of the symptoms associated with LOH could be attributed to the natural process of aging and comorbidities. The goal of this review is to compare the utility and the validity of the different LOH questionnaires. [ABSTRACT FROM AUTHOR]

Objective We assessed the factors significantly associated with lower urinary tract symptoms ( LUTS) in men with late-onset hypogonadism ( LOH) syndrome. Methods The study population consisted of 258 patients aged 40 years or older diagnosed with LOH syndrome. Each patient completed a questionnaire study, such as the International Index of Erectile Function ( IIEF) 5, Aging Male Score ( AMS), and International Prostate Symptom Score ( IPSS). Body mass index ( BMI), waist size, and muscle volume were measured in all patients, and blood biochemical data, including total cholesterol, triglyceride, hemoglobin A1c, and free testosterone (free T), were also collected. We analyzed the factors that have effect on IPSS. Results The mean age of the patients was 64.9 ± 8.7 years, and the mean free T value was 7.3 ± 2.2 pg/mL. The critical factors affecting IPSS were IIEF5 score, BMI, muscle volume, age, AMS, and free T-value ( P < 0.05). Age showed the strongest significant positive correlation with IPSS (r = 0.321, P < 0.001). Each factor was controlled for age. IIEF5 score and AMS were independent factors affecting IPSS (r = −0.221 and 0.195, respectively, P < 0.05). IPSS showed an inverse correlation with IIEF5, and a positive correlation with AMS. LUTS also had a weak negative correlation with Free T-value but this was not significant (r = −0.121, P = 0.061). Conclusion Lower urinary tract symptoms were significantly correlated with erectile function and psychological symptoms in men with LOH syndrome. [ABSTRACT FROM AUTHOR]

Objectives To determine testosterone fractions in Japanese men and to compare these values with those of Framingham Heart Study participants. Methods We enrolled 498 healthy Japanese men. Total testosterone was assayed by liquid chromatography tandem mass spectrometry, sex hormone-binding globulin was assayed by immunoassay and free testosterone was calculated by a laboratory at the Boston Medical Center. Analog-based free testosterone and immunoassay-based total testosterone were determined by immunoassay. We compared mass spectrometry assay-based total testosterone and calculated free testosterone values in the Japanese participants with values in the American Framingham Heart Study third generation cohort. Results The mean serum mass spectrometry assay-based total testosterone, sex hormone-binding globulin, and calculated free testosterone values were 439.4 ± 167 ng/dL, 65.34 ± 30.61 nmol/L, and 58.75 ± 20.0 pg/mL, respectively. The correlation coefficients with age for mass spectrometry assay-based total testosterone, sex hormone-binding globulin, and calculated free testosterone were 0.0010, 0.5041, and −0.496, respectively. There were no age-related changes in mass spectrometry assay-based total testosterone values in healthy men ( P = 0.981), whereas sex hormone-binding globulin and calculated free testosterone levels showed similar age-related changes ( P < 0.0001). Serum analog-based free testosterone levels (8.24 ± 2.9 pg/mL) showed age-related changes ( P < 0.0001) regardless of immunoassay-based total testosterone levels ( P = 0.828). Serum immunoassay-based total testosterone values (486.1 ± 162.5 ng/dL) correlated with serum mass spectrometry assay-based total testosterone values ( r = 0.740, 95% confidence interval 0.6965-0.7781, P < 0.0001). Similarly, analog-based free testosterone and calculated free testosterone values showed a highly significant correlation ( r = 0.706, 95% confidence interval 0.6587-0.7473, P < 0.0001). The analog-based free testosterone values were approximately 10% of the calculated free testosterone values. Conclusions In contrast to the Framingham Heart Study cohort, total testosterone values in Japanese men are not associated with advancing age; thus, they cannot be used to diagnose late-onset hypogonadism in Japan. The analog-based free testosterone value can be considered instead as a suitable biochemical determinant for diagnosing late-onset hypogonadism syndrome. [ABSTRACT FROM AUTHOR]

Over the last 10 years there has been a dramatic increase in the number of patients identified and treated with testosterone replacement therapy (TRT) for late-onset hypogonadism (LOH). By virtue of age, race, and family history, many of these patients are concurrently at risk for harboring indolent prostate cancer. Other men are at increased risk for prostate cancer as a result of an elevated serum PSA level or having had a prior prostate biopsy showing prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP). The clinician is often challenged with the decision whether to initiate TRT in these patients. This review presents a contemporary overview of the rationale for TRT, as well as the relationship between testosterone (endogenous and exogenous) and premalignant and malignant lesions of the prostate. We will discuss preliminary data from several recent series demonstrating that TRT may be safely administered in select patients with certain premalignant and bona fide malignant tumors of the prostate. In the absence of a large randomized clinical trial with long-term outcome data evaluating TRT, we hope that this overview will provide clinicians with an evidence-based approach to managing these anxiety-provoking - and often frustrating - clinical scenarios. [ABSTRACT FROM AUTHOR]

Introduction Late-onset hypogonadism ( LOH) is diagnosed when declining testosterone concentrations in the aging male cause unwanted symptoms such as erectile dysfunction ( ED), reduced bone density and muscle strength, and increased visceral obesity. Testosterone deficiency is also associated with insulin resistance and the metabolic syndrome ( MetS). Restoring testosterone to physiological concentrations has beneficial effects on many of these symptoms; however, it is not known whether these effects can be sustained in the long term. Aims To investigate whether treatment with testosterone undecanoate ( TU) has a long-term and sustained effect on parameters affected by the MetS in men with LOH and ED, to determine whether long-term testosterone treatment can improve the overall health-related quality of life in these men, and to establish the safety of long-term testosterone treatment. Methods Two hundred sixty-one patients (mean age 59.5 ± 8.4 years) diagnosed with LOH and ED were treated with long-acting TU in a prospective, observational, and longitudinal registry study. Men received intramuscular injections of 1,000 mg TU at day 1, at week 6, and every 3 months thereafter. Main Outcome Measures Parameters affected by the MetS, including obesity parameters (body weight, waist circumference, and body mass index [ BMI]), total cholesterol, low-density lipoprotein ( LDL), high-density lipoprotein ( HDL), triglycerides, glucose, HbA1c (glycated hemoglobin), and blood pressure, as well as total testosterone levels and health-related quality of life, were assessed. Results We found TU significantly improved obesity parameters (body weight, waist circumference, and BMI) and lowered total cholesterol, LDL cholesterol, triglycerides, fasting blood glucose, HbA1c, and blood pressure over the 5-year study. HDL cholesterol was increased. TU treatment resulted in a sustained improvement in erectile function and muscle and joint pain, which contributed to an improvement in long-term health-related quality of life. Furthermore, we found a relationship between health-related quality of life and waist circumference. Finally, we found no evidence that long-term treatment with TU increases the risk of prostate carcinoma. Conclusion Long-term TU in men with LOH and ED reduces obesity parameters and improves metabolic syndrome and health-related quality of life. Yassin DJ, Doros G, Hammerer PG, and Yassin AA. Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life. J Sex Med 2014;11:1567-1576. [ABSTRACT FROM AUTHOR]

Rosuvastatin has been used for treatment of dyslipidaemia and metabolic syndrome, but the efficacy has not yet been tested in men with late-onset hypogonadism ( LOH). To assess and compare the efficacy and safety of rosuvastatin in men with dyslipidaemia with LOH and non- LOH, a retrospective study was conducted in patients who received rosuvastatin 10 mg day−1 from the men's health clinic. The primary endpoint was the change in low-density lipoprotein ( LDL)-cholesterol ( C) after 24 weeks of treatment. A total of 145 dyslipidaemic patients eligible for rosuvastatin treatment were enrolled and divided into LOH group (45.52%) and non- LOH (54.48%) group. There were favourable changes in the lipid profiles. In the LOH group whose serum testosterone had been raised by testosterone administration, the favourable changes of the lipids were of similar magnitude as in the non- LOH group. The percentage of patients reaching the target goal ( LDL < 100 mg dL−1) did not differ significantly between the group of non- LOH and LOH men treated with testosterone. Side effects were noted in 1/145 men. It is concluded that rosuvastatin was safe and effective in lowering low-density lipoprotein cholesterol in both non- LOH and LOH dyslipidaemic patients whose serum testosterone levels had normalised. [ABSTRACT FROM AUTHOR]

Introduction Late-onset hypogonadism may impair quality of life and contribute to metabolic and cardiovascular comorbidity in aging men. Testosterone replacement therapy is effective in treating hypogonadism. However, for the millions of men with a history of prostate cancer, exogenous testosterone has long been considered contraindicated, even though little data in such men are available. Clarification of this safety issue could allow treatment to be considered for a sizeable segment of the aging male population. Aim The aim of this study is to examine population-based utilization and impact of testosterone replacement therapy in men with prostate cancer. Methods Using linked Surveillance, Epidemiology, and End Results-Medicare data, we identified 149,354 men diagnosed with prostate cancer from 1992 to 2007. Of those, 1,181 (0.79%) men received exogenous testosterone following their cancer diagnosis. We used propensity scoring analysis to examine the effect of testosterone replacement on the use of salvage hormone therapy and overall and prostate cancer-specific mortality. Main Outcome Measures We assessed overall mortality, cancer-specific mortality, and the use of salvage hormone therapy. Results Following prostate cancer diagnosis, testosterone replacement was directly related to income and educational status and inversely related to age (all P < 0.001). Men undergoing radical prostatectomy and men with well-differentiated tumors were more likely to receive testosterone (all P < 0.001). On adjusted analysis, testosterone replacement therapy was not associated with overall or cancer-specific mortality or with the use of salvage hormone therapy. Conclusions In this population-based observational study of testosterone replacement therapy in men with a history of prostate cancer, treatment was not associated with increased overall or cancer-specific mortality. These findings suggest testosterone replacement therapy may be considered in men with a history of prostate cancer, but confirmatory prospective studies are needed. Kaplan AL, Trinh QD, Sun M, Carter SC, Nguyen PL, Shih YCT, Marks LS, and Hu JC. Testosterone replacement therapy following the diagnosis of prostate cancer: Outcomes and utilization trends. J Sex Med 2014;11:1063-1070. [ABSTRACT FROM AUTHOR]

A small percentage of older men are hypogonadal for no apparent reason other than age, a condition called late-onset hypogonadism. This condition is accompanied by symptoms, especially sexual symptoms, most notably decreased libido. Testosterone treatment of men who have late-onset hypogonadism improves all aspects of sexual function and also mood, depressive symptoms, and self-reported walking ability. Testosterone treatment would not be expected to improve similar symptoms in men who are not unequivocally hypogonadal., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The Aging Males' Symptoms (AMS) score, developed to screen for late-onset hypogonadism (LOH), contains 17 questions regarding mental, physical, and sexual parameters. In the Japanese guidelines, a free testosterone (FT) <8.5 pg/mL is recommended for testosterone treatment. However, previous studies have shown no correlation between total AMS scores and testosterone concentration. We aimed to develop a better questionnaire for the detection of testosterone deficiency in men, for the diagnosis of LOH. In 234 Japanese men, aged 40-64 years, we analyzed the relationships of AMS with serum total testosterone (TT), FT, calculated FT (cFT), and calculated bioavailable testosterone (cBT), and identified useful questions for the detection of testosterone deficiency. Four scores, a decrease in muscular strength, a decrease in ability to perform sexually or the frequency, a decrease in the number of morning erections, and a decrease in sexual desire/libido, were negatively associated with two or more of the above four testosterone parameters, and the sum of these four scores (named the selective score) correlated with TT and cFT, independent of age. Statistical analysis revealed an association between insulin resistance and testosterone deficiency, and a higher selective score in smokers than non-smokers. Cubic function model analysis and logistic regression analysis revealed that selective scores ≥10 corresponded with the testosterone concentrations recommended for the diagnosis of LOH, including FT <8.5 pg/mL, independent of age, insulin resistance, and smoking. Thus, the selective score represents a simple and useful means for screening of testosterone deficiency in Japanese men, as an indicator of LOH.

Total and free testosterone levels decline in men with advancing age due to defects at all levels of the hypothalamic-pituitary-testicular axis. Testosterone treatment of older men with low testosterone levels is associated with improvements in sexual activity, sexual desire, and erectile function; lean body mass, muscle strength, and stair climbing power, and self-reported mobility; areal and volumetric bone mineral density, and estimated bone strength; depressive symptoms; and anemia. Long-term risks of cardiovascular events and prostate cancer during testosterone treatment remain unknown. Testosterone treatment may be offered on an individualized basis to older men with unequivocally low testosterone levels and symptoms or conditions associated with testosterone deficiency after consideration of potential benefits and risks, burden of symptoms, and patient's values., (Copyright © 2022 Elsevier Inc. All rights reserved.)

As men age, their serum concentration of total testosterone decreases only slightly, but because the concentration of sex hormone binding globulin increases, the concentration of free testosterone decreases to a greater degree. The testosterone trials demonstrated that testosterone treatment of elderly men who have low serum testosterone levels increases their sexual function, hemoglobin, and bone mineral density to moderate degrees, and their walking, vitality, and mood slightly. Testosterone treatment increases coronary artery noncalcified plaque volume. However, the trials were not large enough or long enough to know if testosterone treatment increases clinical heart disease or prostate disease., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in men were first published by ISSAM in 2002 In 2005, and, in 2008, updated recommendations were published in the International Journal of Andrology, the Journal of Andrology, the Aging Male and European Urology. Towards discussions at the next ISSAM/ESSAM meeting in Moscow, 29 November 2013, we suggest the following update. [ABSTRACT FROM AUTHOR]

Background: As the population ages, the frequency of late-onset hypogonadism (LOH) has been increasing in primary care. However, there are few data available on the prevalence of LOH among patients of primary care in Asia, particularly in Korea. Methods: To assess the prevalence and associated factors for LOH in primary care, a cross-sectional study was undertaken. A total of 1,235 men aged ≥ 40 years were consecutively enrolled in this study by 18 family physicians from August 2010 to May 2011. An electrochemiluminescence immunoassay was used to measure the total testosterone levels in morning blood samples. Via a structured self-administered questionnaire, subjects were asked about demographic characteristics and lifestyle. Investigating physicians checked concurrent illnesses and measured patient body mass index and abdominal circumference. Results: The crude prevalence rate of LOH was 16.8% (95% confidence interval [95% CI], 14.7-18.9), which increased with age ( p < 0.001). It was significantly higher in patients with abdominal obesity (odds ratio [OR], 1.85; 95% CI, 1.27-2.70), metabolic syndrome (OR, 1.46; 95% CI, 1.02-2.10), and diabetes (OR, 1.57; 95% CI, 1.10- 2.24). Conclusions: These results suggest a prevalence of LOH of 16.8% in men aged ≥ 40 years presenting to family practices. Several other diseases, such as abdominal obesity, metabolic syndrome, and diabetes, as well as age, were associated with LOH. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine late-onset hypogonadism, erectile dysfunction, depression, and quality of life among middle-aged male workers. Methods: The subjects included 343 men aged between 40 and 64, responded to self-report questionnaires on general characteristics, late-onset hypogonadism, erectile dysfunction, depression, and quality of life. Data were collected from May 16, 2012 to October 9, 2012 and analyzed using t-test, ANOVA, χ²-test, hierarchical multiple regression. Result: The prevalence rate of late-onset hypogonadism was 63.8% with high points in reduction of libido, energy, physical strength and endurance, and erectile function. There were significant differences in late-onset hypogonadism according to age (χ²=8.98, p=.048) and in erectile dysfunction according to age (F=11.03, p<.001), monthly income (F=2.84, p=.024) and smoking ( t=2.96, p=.018). Significant differences were also found in depression according to educational level (F=8.12, p<.001) and in quality of life according to monthly income (F=7.21, p<.001). The factors which influenced quality of life were late-onset hypogonadism, erectile dysfunction, depression, marital status and religion. Conclusion: Symptoms of erectile dysfunction can be improved by smoking cessation education program. In order to improve the life quality of middle-aged men, nursing intervention programs that would both provide proper knowledge on climacteric syndrome and alleviate symptoms should be designed while, at the same time, other programs to evaluate, prevent and control depression are developed. [ABSTRACT FROM AUTHOR]

The Aging Male's Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire have been widely used for screening men suspected of late-onset hypogonadism (LOH). We evaluated the consistency of the two questionnaires with sex hormone levels. A total of 985 men completed the two questionnaires, as well as an analysis of the serum levels of total testosterone (TT), bioavailable testosterone (BT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), prolactin (PRL) and sex hormone-binding globulin (SHBG). No correlation was observed between any hormone level and the psychological or somatic section of the AMS score, whereas the sexual section was correlated with the levels of FT, LH, FSH, SHBG and BT. Significant correlations were observed between the result of the two questionnaires and these hormone levels. When LOH was defined as TT < 300 ng/dl and FT < 5 ng/dl, the sensitivity and specificity of the AMS scale were 54.0% and 41.2% compared with 78.7% and 14.8% for the ADAM questionnaire. Several sex hormone levels correlated with the two questionnaires, but neither of these questionnaires had sufficient sensitivity and specificity. It is necessary to provide a new questionnaire applicable to the Chinese population to screening LOH. [ABSTRACT FROM AUTHOR]

Late-onset hypogonadism (LOH) is a relatively common conditions affecting the aging male. The aim of this review is to summarize the available evidence regarding LOH and its interaction with general health. LOH is often comorbid to obesity and several chronic diseases. For this reason lifestyle modifications should be strongly encouraged in LOH subjects with obesity, type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) and good treatment balance of chronic diseases. Medical therapy of LOH should be individualized depending on the etiology of the disease and the patient's expectations. Available evidence seems to suggest that testosterone replacement therapy is able to improve central obesity (subjects with MetS) and glycometabolic control (patients with MetS and T2DM), as well as to increase lean body mass (HIV, chronic obstructive pulmonary disease), along with insulin resistance (MetS) and peripheral oxygenation (chronic kidney diseases). However, it should be recognized that the number of studies on benefits of T supplementation is too limited to draw final conclusions. Longer and larger studies are needed to better clarify the role of TRT in such chronic conditions. [Copyright &y& Elsevier]

Background: Late-onset hypogonadism is more common in individuals with type 2 diabetes mellitus that in the general population. Objectives: To determine the frequency of late-onset hypogonadism in adult males with type 2 diabetes mellitus and erectile sexual dysfunction. Methods: An observational, descriptive study in diabetic men attending the Andrology Consultation Diabetes Care Center at the National Institute of Endocrinology between January 2008 and December 2012. In 283 medical records we studied clinical, biochemical and hormonal variables. Results: Of the sample, 76.3% had late-onset hypogonadism. Age, duration of diabetes mellitus, smokers and diabetic neuropathy was higher in hypogonadal. Hypogonadism is associated with body mass index, waist circumference and waist-hip ratio. Conclusions: chronological age, age at diagnosis of type 2 diabetes mellitus, body mass index, waist circumference, hip circumference, smoking, presence of hypertension and diabetic peripheral neuropathy is associated with the presence of late-onset hypogonadism. There is no association between hypogonadism and severity of sexual erectile dysfunction. [ABSTRACT FROM AUTHOR]

The term 'late-onset hypogonadism (LOH)' is recommended to express the symptoms in middle-aged males with decreased testosterone. Although androgen replacement therapy (ART) might be an effective way to manage LOH, the risk of testosterone supplementation in elderly men is still concerned. On the other hand, to avoid adverse effects of ART, Kampo medicine (traditional Chinese-Japanese medicine) is often a first choice to treat LOH in Japan. However, their pharmacological studies are few. In this study, castrated mice was used as an LOH animal model for examining the pharmacological effects of a Kampo formula, saikokaryukotsuboreito (shortly SKRBT) on serum testosterone levels and seminal vesicles weights. Furthermore, an attempt to elucidate its pharmacological mechanism, inhibition of SKRBT and its components against aromatase were also examined with the enzyme-based assay. As a result, SKRBT improved significantly both the decline of serum testosterone levels and decrease of seminal vesicles weight of castrated mice at a dose of 125 mg/kg with a non dose-dependent manner. SKRBT and two components Scutellariae radix and Rhei rhizoma exhibited inhibitory activities with the IC50 values of 145, 29.2 and 29.7 µg/ml, respectively. These results suggested that the aromatase inhibitory activity of SKRBT may contribute, to a different extent, to the improvement of serum testosterone levels. [ABSTRACT FROM AUTHOR]

With aging, men inevitably encounter irreversible changes, including progressive loss of testosterone and physical strength, and increased fat mass. To assess the alleviatory effects of EUAJ on andropause symptoms, including in vivo testosterone deficiency, we administered EUAJ for 6 weeks in 22-week-old Sprague-Dawley rats. Before EUAJ (3:1) ( E. ulmoides : A. japonica = 3:1, KGC08EA) administration, testosterone decline in 22-week-old SD rats was confirmed compared to 7-week-old SD rats (NC group). After administration of EUAJ (3:1) at 20, 40, and 80 mg/kg for 6 weeks, testosterone, free testosterone, and mRNA expression levels ( Cyp11a1 and Hsd3b1 ) were significantly increased at 40 mg/kg EUAJ (3:1), whereas mRNA expression levels of Cyp19a1 and Srd5a2 were significantly reduced at this concentration, compared to the control group. Swimming retention time was significantly increased at both 40 mg/kg and 80 mg/kg. In summary, EUAJ (3:1) enhanced testosterone production by increasing bioavailable testosterone, sex hormone-binding globulin (SHBG), and enzymes related to testosterone synthesis at 40 mg/kg. In addition, 80 mg/kg EUAJ (3:1) also increased physical and testicular functions., Competing Interests: The authors declare no conflict of interest.

Introduction: The clinical significance of low to low-normal testosterone (T) levels in men remains debated. Aim: To analyze the effects of raising serum T on lean body mass (LBM), fat mass (FM), total body mass, and health-related quality-of-life (HRQoL). Methods: Randomized, double-blind, placebo-controlled study. Men, aged 50-80 years, with serum total T<15 nmol/L and bioavailable T < 6.68 nmol/L, and a Aging Males' Symptoms (AMS) total score >36, received 6 months treatment with transdermal 1% T gel (5-7.5 mg/day; n =183) or placebo gel ( n =179), followed by 12 months open-label with T in all. Results: After 6 months, LBM increased in T- treated patients by 1.28 ± 0.15 kg (mean ± SE) and FM decreased by 1.16 ± 0.16 kg, with minor changes with placebo (LBM +0.02 ± 0.10 kg and FM −0.14 ± 0.12 kg; all p < 0.001, T group vs. placebo). Changes were largely similar across subgroups of age, baseline total testosterone, and baseline BMI. Total HRQoL improved compared with placebo ( p < 0.05, T group vs. placebo). Conclusions: Six months 1% T gel improved body composition and HRQoL in symptomatic men with low to low-normal T, with further improvements over the following 12 months. [ABSTRACT FROM AUTHOR]

Hypogonadism is a common condition which occurs more frequently in older men. It is characterized by low testosterone (T) and is associated with symptoms which are often nonspecific. A key symptom is low libido, but it can also be associated with erectile dysfunction, reduced muscle mass and strength, increased body fat, reduced bone mineral density and osteoporosis, reduced vitality, and depressed mood. Hypogonadism is linked with a variety of comorbid conditions including erectile dysfunction, metabolic syndrome, diabetes, obesity, and osteoporosis. However, the condition is often underdiagnosed. T supplementation in hypogonadism is associated with a range of benefits including improved sexual function, increased lean body mass and/or reduced fat mass, and improved bone mineral density. A variety of T supplementation formulations are available. Although there is no evidence of increased risk of initiating prostate cancer with T supplementation, it is contraindicated in men with prostate cancer. It is important that primary care physicians are aware of both the signs and symptoms of hypogonadism, the monitoring and testing that is required and the merits and advantages of the various T preparations to ensure optimal management of the condition with a treatment approach that best suits patients' needs. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Striant® SR is the only available buccal delivery system for testosterone replacement therapy. Previous pharmacokinetic studies have shown that Striant SR effectively produces physiological serum testosterone levels in hypogonadal men. Efficacy and safety data from previously unpublished studies over 2 years of continuous use indicate that Striant SR is effective long term in maintaining serum testosterone within a physiological range, is well tolerated and has a high level of patient acceptance. Striant® sustained-release (SR) is a mucoadhesive buccal tablet (30 mg testosterone, The Urology Company) that adheres to the gum surface in the mouth providing controlled- and sustained-release of testosterone over a 12-h dosing period, offering a unique and rational method of testosterone delivery. Striant SR is indicated for testosterone-replacement therapy (TRT) for male hypogonadism when testosterone deficiency has been confirmed by clinical features and biochemical tests. Pharmacokinetic studies have shown that testosterone is released from Striant SR in a manner similar to the normal daily rhythm of endogenous testosterone secretion, with serum levels rising rapidly after insertion and peak levels reached by the second 12-hourly dose with no accumulation over time. In clinical trials involving hypogonadal men receiving Striant SR for up to 2 years, mean serum testosterone levels have always remained within the normal range. Striant SR is well tolerated, with gum-related disorders (such as irritation, inflammation and gingivitis) and taste perversion being the most commonly reported adverse events, reported by 5.6-16.3% and 3.0-4.1% of patients, respectively. Once patients have become accustomed to it, Striant SR has a high level of patient acceptance. In a long-term study, 90% of patients rated the twice-daily dosing as acceptable, just under half preferred it to other forms of TRT that they have used and 96% found it to be cosmetically acceptable. There is no clinically significant risk of testosterone transfer from Striant SR, as any testosterone that may be present in the saliva when swallowed is subject to extensive first-pass hepatic metabolism. It is pertinent to note that the saliva of eugonadal men contains similar levels of endogenous testosterone. Buccal delivery is particularly suitable where easy and rapid reversal of treatment might be required (such as in late-onset hypogonadism) and where there is a need to avoid the potential for transfer of testosterone to women and young children. [ABSTRACT FROM AUTHOR]

Background: Despite being one of the relevant public health threats among ageing men, testosterone deficiency syndrome (TDS) is under-recognized and under-diagnosed. Objective: To assess current clinical practices of European physicians regarding diagnosis and management of TDS compared with current guidelines. Methods: Postal survey conducted June-November 2008 in France, Germany, Italy and Spain among urologists, endocrinologists and general practitioners to collect information regarding knowledge of TDS. Results: Among 801 respondents, the majority of endocrinologists and urologists had received training on TDS, either initially or as part of continuous medical education. TDS was recognized by 86.5% of physicians as a true clinical entity, and estimated the prevalence at 10-15% of the male population; 73.5% considered that symptoms and a low level of testosterone were required for diagnosis. Treatment preferences were quarterly intramuscular injections (26.3% of physicians), percutaneous gels (23.9%), matrix patch (21.2%), semi-monthly injections (15.4%) and oral therapy (13.4%). Adverse effects of testosterone replacement therapy, such as benign prostatic hyperplasia and prostate cancer, were a concern for physicians. Conclusions: TDS management appeared to be close to that recommended in international guidelines. Signs and symptoms of testosterone deficiency were fairly well known, but some diagnostic and treatment variations were observed. [ABSTRACT FROM AUTHOR]

In most countries, millions of people are relying on herbal medicines as remedy for numerous ailments. In South-East Asia, Eurycoma longifolia Jack, also known as 'Malaysian ginseng' or Tongkat ali, is used to combat stress and disease and to improve physical strength. Moreover, the compounds of the roots of this plant are reported to have aphrodisiac and testosterone enhancing effects in the rat. Considering that human studies are not available, 76 of 320 patients suffering from late-onset hypogonadism (LOH) were given 200 mg of a standardised water-soluble extract of Tongkat ali for 1 month. The Ageing Males' Symptoms (AMS) according to the standardised rating scale and the serum testosterone concentration were taken. Results show that treatment of LOH patients with this Tongkat ali extract significantly ( P < 0.0001) improved the AMS score as well as the serum testosterone concentration. While before treatment only 10.5% of the patients did not show any complaint according to the AMS scale and 35.5% had normal testosterone levels, after the completed treatment 71.7% and 90.8% of the patients showed normal values, respectively. Thus, Tongkat ali extract appears to be useful as a supplement in overcoming the symptoms of LOH and for the management of hypogonadism. [ABSTRACT FROM AUTHOR]

Objective: This review describes the current knowledge of biological external testosterone (T) application using dermal products for the treatment of late-onset male hypogonadism (LOH). Methods: An English language search of medical literature using Pubmed was conducted between January of 1984 and March of 2012 using the search term 'testosterone gel'. Special emphasis was given to clinical controlled trials and large case studies. Results: We describe the current knowledge on testosterone replacement therapy using gel applications. A reference search revealed 1567 publications; 44 were clinical studies in human patients with male hypogonadism, 80 were reviews, 27 were case reports, and 9 were retrospective studies. Data from the literature and from 20 clinical studies involving human patients were analyzed since they met the inclusion criteria of testosterone gel administration in hypogonadal males. For the purpose of this review, a total number of 2,378 human patients were studied. Overall, biological T administration resulted in improvement of sexual dysfunction and symptoms of metabolic syndrome and represented an effective and safe treatment option for hypogonadal men. Conclusions: Administration of biological T gel appears to represent a valid alternative treatment option for male hypogonadism with a favorite efficacy and safety profile. [ABSTRACT FROM AUTHOR]

In aging men, serum endogenous testosterone is inversely associated with common carotid intima-media thickness (IMT) and directly with beneficial plasma lipid levels; however, the relationship to endothelial function is poorly characterized. We examined the association between serum testosterone and endothelium-dependent brachial artery flow-mediated dilatation (FMD) in middle-aged to elderly men. A group of 83 men aged 40-69 years (mean 55.9 ± 7.5 [SD]) with andropausal symptoms were studied. We measured their serum lipids, testosterone, luteinizing hormone, mean carotid IMT and brachial artery FMD by high resolution B-mode ultrasound. Brachial FMD correlated inversely with vessel diameter ( r == −0.38, p == 0.0004), alcohol consumption ( r == −0.22, p == 0.047) and serum testosterone ( r == −0.27, p == 0.01), but not with luteinizing hormone. In multivariate analysis, FMD was explained by testosterone ( β == −0.17, p == 0.0226), high density lipoprotein cholesterol ( β == 4.17, p == 0.0312) and vessel diameter ( β == −4.37, p < 0.0001) when adjusted for age, body mass index, triglycerides, blood pressure, carotid IMT, smoking, alcohol consumption, cardiovascular diseases and use of lipid lowering medication (HMG-CoA reductase inhibitors). In middle-aged to elderly men, there is an inverse correlation between serum testosterone and brachial FMD. These data suggest that testosterone may have an adverse effect on systemic endothelial function. [ABSTRACT FROM AUTHOR]

Background: Normal testicular function is essential for the maintenance of male physical strength and behaviour irrespective of age. A new term of late-onset hypogonadism (LOH) has been coined for the condition of decreased testosterone (T) and hypogonadal symptoms in ageing men. Objective: The most important testicular hormone, T, is responsible for the gender-specific androgenic-anabolic effects in men. Testicular T production remains stable until around the age of 40 years after which it declines by 1-2% annually. Despite this age-related decline, serum T levels in most older men remain within the reference range of younger men. The decreasing androgen levels are paralleled by well-defined objective biological and nonspecific subjective signs and symptoms of ageing. Because these symptoms are similar to those observed in young men with documented hypogonadism, androgen replacement therapy (ART) has been considered a logical way to treat them. Methods: A thorough review of the existing literature was performed to evaluate the current concepts and controversies related to ageing men and ART. Results: Although it is intuitively logical that the symptoms of LOH are due to the ageing-related deficiency of T, and that they can be reversed by ART, the evidence for this is still variable and often weak. In particular, evidence-based information about long-term benefits and risks of ART in ageing men is largely missing. Conclusions: Despite widespread use, evidence-based proof for the objective benefits and side effects of ART of elderly men is still scanty, and such treatments should be considered experimental. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]