Contents

Search

andropause

Declining androgen levels in older men. Etiology: - old age Pathology: 1) decreased luteinizing hormone (LH) - in advanced old age luteinizing hormone is increased [6] 2) decreased testicular response to LH 3) decreased testosterone secretion from Leydig cells of testes (bioavailable testosterone < 70 ng/dL) 4) decreased adrenal secretion of DHEA & DHEA-sulfate 5) hyporesponsiveness of hypothalamic-pituitary axis to decreased serum testosterone levels Clinical manifestations: (also see hypogonadism) 1) decreased libido 2) erectile dysfunction 3) sarcopenia 4) decreased muscle strength 5) decreased bone mineral density 6) decreased sexual hair 7) increased adipose tissue 8) depression 9) lack of motivation Laboratory: 1) free testosterone < 5 ng/dL 2) total testosterone in serum < 300 ng/dL 3) decreased luteinizing hormone in serum - in advanced old age luteinizing hormone in serum is increased [6] 4) complete blood count (CBC) may show anemia 5) serum LH & serum FSH to distinguish primary from secondary androgen insufficiency 6) aging is associated with increased serum sex hormone binding globulin 7) serum prolactin to assess pituitary function Complications: - low serum testosterone, high serum LH (> 10 IU/L), or very low serum estradiol (< 5.1 pmol/L) associated with increased all-cause mortality [5] - low serum SHBG associated with diminished risk of mortality [5] - U-shaped relationship of serum dihydrotesterone & mortality [5] Differential diagnosis: - a marker of poor health Management: 1) testosterone (also see testosterone replacement therapy) a) Androderm (uncertain value) b) Testoderm (uncertain value) c) Androgel d) testosterone enanthate or cyprionate IM e) lack of substantial evidence to support its use [4] 2) re-evaluate 3, 6 & 12 months after initiation of therapy, thereafter at least annually [2] - monitor hematocrit, serum PSA

Related

erectile dysfunction (ED) testosterone (Delatestryl Testopel, Striant, Intrinsa, Xyosted) testosterone replacement therapy; androgen therapy

General

age-related endocrinopathy hypogonadism

References

  1. Solomon DH, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Kazi M et al, Considerations for the diagnosis and treatment of testosterone deficiency in elderly men. Am J Med 2007, 120:835 PMID: 17904450
  3. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  4. Nguyen CP, Hirsch MS, Moeny D et al Perspective. Testosterone and "Age-Related Hypogonadism" - FDA Concerns. N Engl J Med 2015; 373:689-691. August 20, 2015 PMID: 26287846 http://www.nejm.org/doi/full/10.1056/NEJMp1506632
  5. Yeap BB, Marriot RJ, Dwivedi G et al Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses. Ann Intern Med 2024. May 14. PMID: 38739921 Review. https://www.acpjournals.org/doi/10.7326/M23-2781
  6. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022