Testosterone replacement therapy for older men.

Summary A review of the currently published data indicates thattestosterone replacement therapy in older men may beadvantageous in terms of improving bone mineral density,increasing muscle mass and strength, and, in some men,improving libido and mood. However, the long-term clin-ical signiﬁcance of these effects is still uncertain, as largerand longer-term studies are needed. In the short term (upto 3 years), the adverse effects of testosterone replace-ment therapy in older men seem predictable and manage-able, but the longer-term effects on target organs, such asthe cardiovascular system and the prostate, are yet to bedetermined. References AACE Hypogonadism Task Force. American Association of Clinical En-docrinologists medical guidelines for clinical practice for the evalu-ation and treatment of hypogonadism in adult male patients—2002update. Endocr Pract. 2002;8:439–456.Anonymous. Incidence of vertebral fracture in Europe: results from theEuropean Prospective Osteoporosis Study (EPOS). J Bone Miner Res.2002;17:716–724.Arver S, Dobs AS, Meikle AW, Caramelli KE, Rajaram L, Sanders SW,Mazer NA. Long-term efﬁcacy and safety of a permeation-enhancedtestosterone transdermal system in hypogonadal men. Clin EndocrinolOxford. 1997;47:727–737.Baker HW, Burger HG, de Kretser DM, Hudson B, O’Connor S, WangC, Mirovics A, Court J, Dunlop M, Rennie GC. Changes in the pi-tuitary-testicular system with age.Clin Endocrinol Oxford. 1976;5:349–372.Basaria S, Dobs AS. Hypogonadism and androgen replacement therapyin elderly men. Am J Med. 2001;110:563–572.Bhasin S, Bagatell CJ, Bremner WJ, Plymate SR, Tenover JL, KorenmanSG, Nieschlag E. Issues in testosterone replacement in older men. JClin Endocrinol Metab. 1998;83:3435–3448.Bhasin S, Bremner WJ. Emerging issues in androgen replacement ther-apy. J Clin Endocrinol Metab. 1997;82:3–8.Bhasin S, Gabelnick HL, Spieler JM, Swerdloff RS, Wang C, Kelly C,eds. Pharmacology, Biology and Clinical Applications of Androgen.New York, NY: Wiley Liss; 1996.Bhasin S, Swerdloff RS, Steiner B, Peterson MA, Meridores T, GalmiriniM, Pandian MR, Goldberg R, Berman N. A biodegradable testoster-one microcapsule formulation provides uniform eugonadal levels oftestosterone for 10–11 weeks in hypogonadal men. J Clin EndocrinolMetab. 1992;74:75–83.Blum J, Harris RH. Diagnosis and treatment of hypogonadism with em-phasis on erectile dysfunction and osteoporosis. Prim Care Case Rev.2003;6:97–109.Bouloux P. Testim 1% testosterone gel for the treatment of male hypo-gonadism. Clin Ther. 2005;27:286–298.Bremner WJ, Prinz PN. A loss of circadian rhythmicity in blood testos-terone levels with aging in normal men. J Clin Endocrinol Metab.1983;56:1278–1281.Brocks DR, Meikle AW, Boike SC, Mazer NA, Zariffa N, Audet PR,Jorkasky DK. Pharmacokinetics of testosterone in hypogonadal menafter transdermal delivery: inﬂuence of dose. J Clin Pharmacol. 1996;36:732–739.Cunningham GR, Cordero E, Thornby JI. Testosterone replacement withtransdermal therapeutic systems. JAMA. 1989;261:2525–2530.Davidson JM, Chen JJ, Crapo L, Gray GD, Greenleaf WJ, Catania JA.Hormonal changes and sexual function in aging men. J Clin Endo-crinol Metab. 1983;57:71–77.Dobs AS, Meikle AW, Arver S, Sanders SW, Caramelli KE, Mazer NA.Pharmacokinetics, efﬁcacy, and safety of a permeation-enhanced tes-tosterone transdermal system in comparison with bi-weekly injectionsof testosterone enanthate for the treatment of hypogonadal men. J ClinEndocrinol Metab. 1999;84:3469–3478.Ferrini RL, Barrett-Connor E. Sex hormones and age: a cross-sectionalstudy of testosterone and estradiol and their bioavailable fractions incommunity-dwelling men.Am J Epidemiol. 1998;147:750–754.Findlay JC, Place V, Snyder PJ. Treatment of primary hypogonadism inmen by the transdermal administration of testosterone. J Clin Endo-crinol Metab. 1989;68:369–373.