11: Androgen deficiency and replacement therapy in men

David J Handelsman and Jeffrey D Zajac
Med J Aust 2004; 180 (10): 529-535.


  • 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.

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  • David J Handelsman1
  • Jeffrey D Zajac2

  • 1 ANZAC Research Institute, Concord Hospital, Sydney, NSW.
  • 2 Department of Medicine, University of Melbourne, Austin Hospital, Melbourne, VIC.


Competing interests:

D J H: Consultant to Besins (France) and Lawley (Australia) for clinical trials of testosterone cream and gel. J Z: None identified..

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