Androgen deficiency in the aging male (ADAM), also known as andropause, affects an estimated 1 in 200 men.
Symptoms of testosterone deficiency may include:
- Reduced libido
A man may be considered hypogonadal at any age if total testosterone is less than 200 ng/dl or bioavailable testosterone is less than 60 ng/dl. Basaria and Dobs of Johns Hopkins University recommend that elderly men with symptoms of hypogonadism and a total testosterone level < 300ng/dl should be started on hormone replacement.
Goals of Testosterone Replacement Therapy in Adult Hypogonadal Men (age 50 or older)
- Improvement in psychological well-being and mood
- Improvement in erectile dysfunction
- Improvement in libido
- Increased muscle mass
- Increased strength and stature
- Preservation of bone mass
- Possible decrease in cardiovascular risk
What is the Optimal Form of Testosterone for Replacement Therapy?
Testosterone USP is natural bio-identical testosterone that has been approved by the United States Pharmacopoeia and is available as a bulk chemical. Upon a prescription order, compounding pharmacists can use Testosterone USP to prepare numerous dosage forms.
Natural testosterone replacement is central to the treatment of all facets of andropause. The term “testosterone” is often used generically when referring to numerous synthetic derivatives as well as natural bio-identical testosterone. Confusion is responsible for conflicting data in the medical literature about the benefits and risks of testosterone therapy, and studies must be reviewed carefully to determine the form of testosterone that was used. Natural testosterone must not be confused with synthetic derivatives or “anabolic steroids,” which, when used by athletes and body builders, have caused disastrous effects. For example, administration of synthetic non-aromatizable androgens like stanozolol or methyltestosterone causes profound decreases in HDL-C (“good cholesterol”) and significant increases in LDL-C (“bad cholesterol”). Yet hormone replacement with aromatizable androgens such as testosterone results in lower total cholesterol and LDL cholesterol levels while having little to no impact on serum HDL cholesterol levels. Proper monitoring of laboratory values and clinical response are essential when prescribing testosterone replacement therapy.
The only absolute contraindications to androgen replacement therapy are the presence of prostate or breast cancer. “Although it is known that the clinical course of prostate cancer is accelerated by testosterone, its incidence is not increased by [testosterone] administration… There is even no clear evidence that testosterone replacement accelerates the development of BPH.”