Abstract
Most cross-sectional studies and one recent longitudinal study suggest that testosterone levels in healthy men decline slowly and that this decline begins during middle age. The decline in "free" or unbound testosterone is greater than the decline in total testosterone levels. Physiologic sequellae of lower testosterone levels may include a decrease in muscle mass, increase in body fat, decreased bone density, and a variety of changes in sexual function. Long-term studies of androgen replacement are currently in progress. Short-term studies suggest that, for some men, androgen replacement may increase libido and muscle strength and decrease abdominal fat. The available data suggest that androgens do not generally worsen symptoms of prostatic hypertrophy or stimulate the development of prostate cancer. Lipid profiles may be slightly improved during androgen replacement, but the long-term effects of androgens on the cardiovascular system are unknown. Hematocrit and hemoglobin frequently rise in response to androgen administration. In most men, these increases are small, but in some men they can be significant. Liver toxicity can occur with use of alkylated androgens, but it is extremely rare with the use of testosterone esters. Men receiving androgens should have periodic monitoring of their prostate, serum prostate-specific antigen level, lipids, hematocrit, and liver functions. Future androgens, with minimal effects on the prostate, may become available for clinical use.
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