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Androgens and the ageing male and female

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Abstract

Androgens play a number of important physiological roles in the human. In the male, testosterone is required for virilization, normal sexual function, and both stimulation and maintenance of bone and muscle mass. Epidemiological studies have shown a progressive decline in testosterone levels with ageing in men. The clinical significance of this decline is still unclear, and there is controversy as to whether a specific syndrome of androgen deficiency or ‘andropause’ exists. The benefits of testosterone supplementation in this age group have yet to be equivocally established, and long-term safety data on testosterone administration in this setting are lacking. In the female, a decline in testosterone levels with ageing has been less clearly established due, at least in part, to the absence of sensitive assays. Available data suggest that the major role of testosterone replacement after menopause may be in those women who have had an oophorectomy.

Section snippets

Changes in testosterone levels with ageing

Numerous cross-sectional studies have evaluated testosterone levels in the ageing male with conflicting results. Some of these studies have shown a decline in testosterone levels with ageing3., 4., 5., 6., 7., whereas others have shown similar testosterone levels in older and younger men.8., 9. The different conclusions of these studies may be explained by small sample size, differences in the overall health of the study subjects, and the timing of sample collection. Data from a meta-analysis

Androgens and the post-menopausal female

Despite optimal oestrogen replacement, a significant number of post-menopausal women continue to remain symptomatic, with symptoms of decreased energy and decreased libido. These observations led to the hypothesis that androgens might play an important role in the female as well as in the male. Unlike the male, in whom a syndrome of androgen deficiency has been well described, there is no widely accepted definition of androgen deficiency in the female. Due to the lack of a specific definition

Summary

The role of androgen replacement in older men is still uncertain. Many of the symptoms that are indicative of hypogonadism in young men are non-specific in the older population. In older men, existing data support a threshold testosterone level below which bone health and sexual function may be compromised. More research needs to be done to determine the dose–response curves for testosterone at different tissues and whether the positive end-organ effects with testosterone replacement are due to

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