As the number and proportion of old...

As the number and proportion of older men increase in the United States and elsewhere, therapy to help healthy aging becomes more advantageous. Aging in men has been associated with a inactive decline in testosterone (T) of the same heights as well as various clinical changes (eg as declining muscle mass, declining bone mineral density, and increased fat) that mimic the symptoms of androgen deficiency in younger men Androgen supplementation is known to have positive drifts on muscle mass, bone density, and solidity but longitudinal population-based studies are requireed to assess its safety and benefits in older men To shed light forward these issues, Liu and associates reviewed randomized controll trials of androgen supplementation lasting for at least three month in men older than 60 years.

Seven studies reported the powers of standard- dose androgen supplementation upon muscle and fat in men with grave to normal serum T horizontals All seven showed a unobtrusive reduction in body fat mass and a small increase in muscle mass, although it is unclear whether of the like kind small differences would improve daily function in an older more frail population. The potential improvement in insulin sensitivity that might be rely uponed with a decrease in material part fat was not seen, whether patients were complemented with an aromatizable androgen (testosterone) or a nonaromatizable androgen (eg dihydrotestosterone, oxandrolone [Oxandrin]).

Three studies analyzed the consequences of androgen therapy on bone mineral density. These studies showed that improvement in skeletal bone contented in older men is more likely when a higher dose of intramuscular T is used and when the patient has a lower baseline T concentration. Another trial plant that although T and nandrolone increased muscle vigor only T increased bone mineral density. Aromatizability therefore appears to be essential for bone mass improvement, which may aid in the choice of androgen used in further studies.

The efficiencys of T supplementation on the risk of prostate cancer and symptomatic prostatic enlargement are not known; its efficiencys on cardiovascular risks in older men are unclear and require further meditation Two trials relating to sleep-disordered breathing indicate that high-dose testosterone supplementation worsens repose apnea and polycythemia in older men; further dosing-related safety studies are needed

The authors deduce that features of T deficiency syndrome include (1) clinical signs and symptoms so as lethargy, fatigue, diminished libido, cast downed mood, reduced muscle and bone mass, increased visceral fat, impotence, and mild cognitive impairment; and (2) a total T concentration of les than 200 ng by dL (7 nmol per L) A T concentration of 200 to 400 ng through dL (7 to 14 nmol by means of L) could indicate androgen deficiency, on the other hand a concentration greater than 400 ng by dL excludes the diagnosis. A secondary confirmatory test is needed before treatment is initiated. Bioavailable T or independent T tests may clarify borderline situations and may be particularly useful in older men because serum sex-hormone-binding globulin increases with age. Before treatment, physicians should determine the cause of decreased T plains (primary or secondary); perform a digital prostate examination, prostate-specific antigen life-blood test, and complete blood count; and consider a reduc initial dose to minimize adverse tenors Random blood T measures during treatment probably are not useful unles androgen-dependent symptoms fall out More research is needed regarding the benefit and safety of T supplementation in older men with androgen deficiency syndrome

Liu PY et al. The rationale, efficacy and safety of androgen therapy in older men: to come research and current practice recommendations. J Clin Endo Metab October 2004;89:4789-96

EDITOR'S NOTE: Biochemical testing is essential for an accurate diagnosis of androgen deficiency syndrome Routine laboratory screening for hypogonadism is not commended in patients without clinical symptoms or signs. Suspected hypogonadism can be evaluated with a total testosterone (T) assay. clear T levels may be more useful when elevated or decreased sex-hormone-binding globulin (SHBG) could alter the biologically available fraction of measured T Obesity, prototype 2 diabetes, and hypothyroidism are associated with depressed SHBG levels, whereas older age is associated with increasing SHBG Testing released T levels or total bioavailable T can give accurate measurements in these situations further unfortunately, the bioavailable T flats assay is difficult to perform, and independent T assays also require specialized laboratory standardizations and techniques. The mostly reliable assay for free T is equilibrium dialysis. a physicians measure total T and SHBG as a compromise, allowing calculation of a Testosterone independent Index using the formula Total T/SHBG x 100; a useful calculator can be rest on the Internet at http://www.issam. ch/freetesto.htm.--R.S.

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