Age related Hypogonadism

Testosterone, traditionally believed to be important only for male reproduction and sexuality, is now recognized as having wide-ranging health benefits.[1]

In addition to giving rise to male sexual characteristics, such as facial hair, muscularity, sexual function, and male the psyche, testosterone is also essential for maintaining a healthy body composition, bone mass as well as a positive mood and vigor.[2-5]

Accumulating evidence shows that testosterone is critical for metabolic and vascular health.[6-8]. The metabolic effects of testosterone explain why testosterone deficiency contributes to the development of obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM).[9,10-14]

Numerous studies have also shown that testosterone is a vasoactive hormone, with predominantly vasodilatory actions, that has beneficial effects on several cardiovascular risk factors, including lipids, endothelial dysfunction, and inflammation, which are key mediators of atherosclerosis.[15,16

Due to the multiple effects of testosterone on many organ systems, the health consequences of low testosterone or age related hypogonadism can be wide-ranging.

Hence, symptomatic hypogonadism merits treatment, and at 23MD we measure and waiting testosterone both for men and women when clinica

lly indicated by blood testing and symptoms.

Several studies have shown that low testosterone levels are associated with increased mortality,[17-38] and there is increasing evidence that TRT may reduce cardio-vascular-related and all-cause mortality.[39] Two notable prospective studies showed that TRT reduces mortality by half in men with and without diabetes mellitus.[40]

IN summary, the importance of low-T in men’s health is now firmly established; and, if left untreated, the condition has many detrimental health effects.

It is therefore very important that men with suspected low testosterone undergo diagnostic evaluation and, if a diagnosis is confirmed, are treated and monitored.

The benefits of TRT for men with hypogonadism are well established and have been shown to outweigh the risks for the majority of patients, in particular those who are obese or have type 2 diabetes.

In spite of suggestions that TRT is associated with an increased risk for prostate cancer and CV disease, evidence from trial data does not support this.

Therefore, patients without contraindications should be offered TRT

A variety of formulations are available that have been shown to improve quality of life and reduce mortality among men with hypogonadism.

Please contact us here to make an appointment for your assessment.

References

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2. Isidori AM, Giannetta E, Greco EA, Gianfrilli D, Bonifacio V, Isidori A, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf). 2005;63:280-293. Abstract 


3. Wang C, Swerdloff RS, Iranmanesh A, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab. 2000;85:2839-2853. Abstract 


4. Wang C, Cunningham G, Dobs A, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab. 2004;89:2085-2098. Abstract 


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7. Kelly DM, Jones TH. Testosterone: a metabolic hormone in health and disease. J Endocrinol. 2013;217:R25- R45. Abstract 


8. Saad F, Gooren LJ. The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. J Obes. 2011;2011. 


9. Kelly DM, Jones TH. Testosterone: a metabolic hormone in health and disease. J Endocrinol.

10. Saad F. Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease? Diabetes Metab Res Rev. 2012;28 Suppl 2:52-59. Abstract 


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12. Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. J Androl. 2009;30:10-22. Abstract 


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22. Haring R, Nauck M, Volzke H, et al. Low serum testosterone is associated with increased mortality in men with 
stage 3 or greater nephropathy. Am J Nephrol. 2011;33:209-217. Abstract 


23. Haring R, Volzke H, Steveling A, et al. Low serum testosterone levels are associated with increased risk of 
mortality in a population-based cohort of men aged 20-79. Eur Heart J. 2010;31:1494-1501. Abstract 


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28. Corona G, Monami M, Boddi V, et al. Low testosterone is associated with an increased risk of MACE lethality in subjects with erectile dysfunction. J Sex Med. 2010;7:1557-1564. Abstract 


29. Menke A, Guallar E, Rohrmann S, et al. Sex steroid hormone concentrations and risk of death in US men. Am J Epidemiol. 2010;171:583-592. Abstract 


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40. Shores MM, Smith NL, Forsberg CW, Anawalt BD, Matsumoto AM. Testosterone treatment and mortality in men with low testosterone levels. J Clin Endocrinol Metab. 2012;97:2050-2058. Abstract