Clinical Briefs-By Louis Kuritzky, MD

Testosterone Supplementation in the Aging Male

The role of testosterone in achieving and maintaining erections in sexual settings (as opposed to "central" erections occurring spontaneously in a cyclic fashion throughout the day and night) remains uncertain. Men who are deficient in testosterone may suffer ED, which may respond to testosterone supplementation, but the frequency of testosterone deficiency as a cause of ED in aging men is extremely low, typically less than 5%.

Much of the population of senior men who demonstrate low testosterone levels suffer from other significant health problems, and it is unclear whether these additional disorders are precipitants for the decline in testosterone levels. Since testosterone supplementation is not without consequence (economic costs, exacerbation of BPH, induction or exacerbation of prostate cancer, worsened lipid profile risk patterns), it is important to ascertain the (potential) value of such supplementation.

Overt hypogonadism is found in only about 4% of men over age 40-70, if defined as both low testosterone and high gonadotropins. If levels of bioavailable testosterone are the measurement designated to define clinically relevant hypogonadism, as many as 35% of men over age 60 will be hypogonadal and may benefit from testosterone supplementation.

Kim suggests that in clinical settings where symptoms suggest hypogonadism, testosterone supplementation may be considered; dosages should provide a serum testosterone level of at least 240 ng/dL. There is an important need for a large, long-term trial to ascertain the risk-benefit relationship of testosterone supplementation in the elderly.

Kim YC. Int J Impot Res 1999;11: 343-352.