Androgen deficiency is a clinical diagnosis confirmed by hormone assays.
Among younger men, androgen deficiency is usually due to underlying hypothalamopituitary or testicular disorders.
Androgen replacement therapy should be started after proof of androgen deficiency and should continue lifelong with monitoring.
Men presenting with erectile dysfunction should be evaluated for androgen deficiency, but it is an uncommon cause; if overt androgen deficiency is confirmed, an underlying disorder needs further specialist investigation.
In the absence of characteristic underlying testicular or pituitary disorders, new diagnosis of androgen deficiency in older men is difficult because of the non-specific symptoms and the decline in blood testosterone levels seen in healthy ageing and chronic medical disorders.
There remains no convincing evidence that androgen therapy is either effective treatment or safe for older men unless they have frank androgen deficiency.
- 1. Handelsman DJ. Androgen action and pharmacologic uses. In: DeGroot LJ, editor. Endocrinology. 4th ed. Philadelphia: W B Saunders, 2001: 2232-2242.
- 2. Bojesen A, Juul S, Gravholt CH. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study. J Clin Endocrinol Metab 2003; 88: 622-626.
- 3. Abramsky L, Chapple J. 47,XXY (Klinefelter syndrome) and 47,XYY: estimated rates of and indication for postnatal diagnosis with implications for prenatal counselling. Prenat Diagn 1997; 17: 363-368.
- 4. Gooren LJ. Androgen levels and sex functions in testosterone-treated hypogonadal men. Arch Sexual Behaviour 1987; 16: 463-473.
- 5. Buena F, Peterson MA, Swerdloff RS, et al. Sexual function does not change when serum testosterone levels are pharmacologically varied within the normal male range. Fertil Steril 1993; 59: 1118-1123.
- 6. Conway AJ, Handelsman DJ, Lording DW, et al, on behalf of the Endocrine Society of Australia. Use, misuse and abuse of androgens: the Endocrine Society of Australia consensus guidelines for androgen prescribing. Med J Aust 2000; 172: 220-224. <MJA full text>
- 7. Liu PY, Death AK, Handelsman DJ. Androgens and cardiovascular disease. End Rev 2003; 24: 313-340.
- 8. Arver S, Dobs AS, Meikle AW, et al. Long-term efficacy and safety of a permeation-enhanced testosterone transdermal system in hypogonadal men. Clin Endocrinol (Oxf) 1997; 47: 727-737.
- 9. Wang C, Swedloff RS, Iranmanesh A, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. Testosterone Gel Study Group. J Clin Endocrinol Metab 2000; 85: 2839-2853.
- 10. Handelsman DJ. Testosterone implants: a manual of scientific and clinical information. Auckland: Stredder Print, 1991.
- 11. Handelsman DJ, Conway AJ, Boylan LM. Pharmacokinetics and pharmacodynamics of testosterone pellets in man. J Clin Endocrinol Metab 1990; 71: 216-222.
- 12. Jin B, Conway AJ, Handelsman DJ. Effects of androgen deficiency and replacement on prostate zonal volumes. Clin Endocrinol (Oxf) 2001; 54: 437-445.
- 13. Zitzmann M, Depenbusch M, Gromoll J, Nieschlag E. Prostate volume and growth in testosterone-substituted hypogonadal men are dependent on the CAG repeat polymorphism of the androgen receptor gene: a longitudinal pharmacogenetic study. J Clin Endocrinol Metab 2003; 88: 2049-2054.
- 14. Handelsman DJ. The safety of androgens: prostate and cardiovascular disease. In: Wang C, editor. Male reproductive function. Boston: Kluwer Academic Publishers, 1998: 173-190.
- 15. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab 2002; 87: 589-598.
- 16. Gruenewald DA, Matsumoto AM. Testosterone supplementation therapy for older men: potential benefits and risks. J Am Geriatr Soc 2003; 51: 101-115.
- 17. Barrett-Connor E, Bhasin S. Time for (more research on) testosterone. J Clin Endocrinol Metab 2004; 89: 501-502.
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