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Cited by 18Hormonal and reproductive studiesMenopause: Health Impacts and TreatmentsAdrenal Hormones and Disorders

Testosterone therapy in older men with late-onset hypogonadism: a counter-rationale

Basaria, Shehzad·2013·Endocrine Practice
DOI 10.4158/ep13318.ra
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Abstract

Objective The past decade has seen a surge in referrals of older men for consideration of testosterone therapy for late-onset hypogonadism (LOH) to treat symptoms such as fatigue, sexual dysfunction and decreased vitality. Prescription sales of testosterone have accordingly increased by 20-fold over the same period, due mainly to marketing campaign as well as to the failure of clinicians to distinguish organic hypogonadism from LOH. This review seeks to provide a counter-rationale for testosterone therapy in LOH.Methods A retrospective review of English-language epidemiologic studies, clinical trials and their relevant cited studies related to testosterone and older men was carried out.Results Shortcomings of population studies on LOH include use of multiple numeric definitions and non-standard testosterone assays, and measurement of testosterone at a single time point. In contrast to higher estimates of prevalence based solely on numeric values, the syndromic prevalence of LOH is only 2%. Although attrition of testicular Leydig cells and slowing of gonadotropin-releasing hormone neurons both contribute to LOH, obesity and other comorbidities strongly influence testosterone levels, suggesting that testosterone is a biomarker of health. Testosterone therapy in LOH has consistently resulted in improvements in muscle mass and strength, although data regarding effects on physical function and improvements in fall and fracture rates remain unknown. Eythrocytosis is the most common adverse effect of testosterone therapy in older men, while long-term risks in the prostate and cardiovascular system remain unclear.Conclusion Considering the paucity of data on clinically meaningful outcomes, the number of uncertain risks, and the fact that modifiable risk factors adversely influence testosterone levels, healthy lifestyle and treatment of comorbidities might attenuate age-related declines in testosterone levels.

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  • In middle-aged and older men with functional hypogonadism, androgen deficiency-like symptoms may be caused by, or at least contributed to by, their comorbid burden, instead of, or in addition to, their low testosterone levels.

    “In such men, androgen deficiency–like symptoms may be caused by, or at least contributed to by, their comorbid burden, instead of, or in addition to, their low testosterone levels (Table 1) (7).”

    From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [7]

  • Provided specific pathologic etiologies of functional hypogonadism such as hyperprolactinemia or endogenous Cushing syndrome have been excluded, unexplained low serum testosterone concentrations could be due to functional HPT axis suppression caused by excess adiposity, comorbid illness, and/or medications such as opioids or glucocorticoids.

    “Provided that specific pathologic etiologies of functional hypogonadism such as hyperprolactinemia or endogenous Cushing syndrome [Fig. 1(a)] have been excluded, the unexplained low serum testosterone concentrations could be due to functional HPT axis suppression caused by excess adiposity, comorbid illness, and/or medications such as opioids or glucocorticoids.”

    From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [7]

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Authors
Basaria, S.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Basaria, Shehzad
ORCID
Basaria, Shehzad
Venue
Endocrine Practice
Publisher
Elsevier BV
Published
2013-09
Volume
19
Issue
5
Pages
853-863
ISSN
1530-891X (ISSN-L)
DOI
10.4158/ep13318.ra
OpenAlex
W1977581233
Cited by
18
References
75
Citations by year
2026: 1 · 2024: 1 · 2022: 1 · 2021: 3 · 2019: 1 · 2017: 1 · 2016: 4 · 2015: 2 · 2014: 4
FWCI
0.49
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Endocrine Practice (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
testosterone replacement therapy, andropause, older men, GnRH neurons, obesity, comorbidities, erythrocytosis, prostate cancer risk, cardiovascular risk, muscle mass and strength
MeSH terms
Androgens, Humans, Hypogonadism, Male, Risk Factors, Testosterone, Hormone Replacement Therapy

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