Serum testosterone levels decline progressively with age. An estimated 20% of men over the age of 60 years have testosterone levels below the normal range for young men. Ageing men display symptoms similar to those observed in young men with hypogonadism. These symptoms combined with low serum testosterone comprise the entity often referred to as andropause. However, the clinical significance of this decline in testosterone levels remains uncertain. Whereas the testosterone substitution therapy for young men with hypogonadism appears to be beneficial, there is no clear-cut evidence of clinical benefits of such therapy in healthy elderly men with moderately decreased testosterone levels.
We aimed at evaluating the benefits of androgen replacement therapy in andropausal otherwise healthy men in a randomised placebo-controlled setting. Initially all men between the ages of 4070 living in the City of Turku (total population 170.000) were sent a questionnaire (Heinemans questionnaire) about the andropausal symptoms. Those with a high symptom score were invited for serum testosterone measurement and the symptoms were re-evaluated. The association of andropausal symptoms and serum testosterone levels was also studied in those individuals with high symptom scores. In order to ensure patient safety and avoid the confouding effect of diseases, men with significant disease or contraindications for androgen replacement therapy were excluded. The very low number of strictly healthy men with andropausal symptoms and decreased serum testosterone (<9.8 nmol/l) did not allow the required power for statistical analysis of the possible benefits of testosterone replacement and the study had to be discontinued.
Our findings suggest that the incidence of andropause in otherwise healthy men is presently being overestimated. Furthermore, the association of the so called andropausal symptoms and decreased serum testosterone requires further evaluation before androgen replacement therapy of the elderly can be considered evidence based treatment.
01 - 05 Apr 2006
European Society of Endocrinology