Adult-onset hypogonadism is used to define androgen deficiency and its associated symptoms commonly occurring in middle-aged and elderly men, who are unable to mount an adequate compensatory gonadotropin response but may also have an element of testicular failure. It often occurs in relation with chronic metabolic conditions such as diabetes and the metabolic syndrome. There is a growing demand from elderly men for testosterone therapy. The physician should therefore be well-informed so as the patient can make an informed decision. Indeed, testosterone therapy in older men has been a matter of debate, especially with regard to its impact on cardiovascular events and mortality. Not all studies have reported consistent results regarding its effect on diabetes, obesity and the metabolic syndrome. In contrast, it appears to improve sexual, physical function and bone density and it does not appear to increase the risk of prostate cancer; however, it increases haematocrit and haemoglobin levels. Therefore, testosterone therapy might provide significant beneficial effects in older symptomatic hypogonadal men; treatment should be individualised, and co- morbidities addressed. Further research is required into its long-term effects.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2019 Jan 28 [Epub ahead of print]
Carol Cardona Attard, Stephen Fava
Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta., Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta - .