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Vermeulen A. Andropause. Maturitas 2000;34:5-15.
Abstract: Although, in distinction to middle aged women, in
middle aged men there does not occur a sudden arrest of gonadal
functions, fertility persisting until very old age, aging
in men is, nevertheless, associated with an gradual decline
of both endo- and exocrine testicular function. Whereas age
has in fact only minimal effects on the quality of the ejaculate,
endocrine function declines steadily with age and at age 75
years, mean plasma testosterone levels are only 65% of levels
in young adults whereas over 25%, of these men have bioavailable
testosterone levels below the lower normal limit in young
adults. The interindividual variations in the plasma levels
are, however, very important and a quarter of men over 75
years old, have still testosterone levels within the upper
quartile of values in young men. Aging is accompanied by a
series of signs and symptoms, many of which are rather similar
to those observed in young hypogonadal males. The etiology
of these signs and symptoms is often multifactorial, and very
few correlations have been found between symptoms and plasma
testosterone levels. Nevertheless, there is good evidence
that the age associated decrease in testosterone levels is
at least a co-determinant of these symptoms and testosterone
supplementation has shown favorable effects on many of them.
Side effects of this substitutive therapy are minimal when
care is taken to keep plasma testosterone levels within the
physiological range. Clinical prostatic carcinoma is an absolute
contra-indication for testosterone supplementation. So far,
there are no indications that testosterone would stimulate
the evolution of as subclinical prostatic carcinoma to a clinical
carcinoma but it should be recalled that so far, only a small
number of elderly males received substitutive androgen treatment
for longer periods in controlled studies. Hence, although
side effects are generally minimal, one should, nevertheless,
await the results of larger, long term, well- controlled studies
before to recommend the routine testosterone substitution
of elderly men
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