[Testosterone substitution in patients with hypogonadism].
OBJECTIVE
After the age of 60, 20-35% of men present with androgen deficiency. Clinical symptoms of hypogonadism in older men are often more difficult to interpret than in younger men. Knowledge of physiological actions of testosterone and its metabolites are important prerequisites for diagnosis, drug selection and surveillance of therapy. Another question is whether any type of interventions, such as hormone replacement therapy, may play a role in improving the quality of life as proven in post-menopausal women.


METHODS
To understand testosterone supplementation in the aging male, this review will discuss the following important topics: physiology of male hormonal balance, changes in reproductive organs in elderly men, endocrine evaluation of the male, pharmacological effects of testosterone on target organs, available preparations for testosterone and testosterone supplementation.


RESULTS
Testosterone deficiency may induce organic symptoms such as loss of muscular strength, decreased libido and loss of bone density and have psychological consequences such as fatigue or depression. Controlled clinical trials show that therapy with natural testosterone results in clinical improvements in elderly men that cover androgenic effects.


CONCLUSIONS
With the current status of knowledge short acting, low dose testosterone preparations seem to be best tailored for substitution of older hypogonadal men. Only intensive research in the future can satisfy these requirements.
Martínez Portillo
Francisco José
FJ
Departamento de Urología, Clínica Universitaria de Kiel, Universidad de Kiel, Alemania. fmartinez@urology.uni-kiel.de
Cueva Martínez
Armando
A
Martin Braun
Peter
P
Fernández Arancibia
Mario Ignacio
MI
Jünemann
Klaus-Peter
KP
Alken
Peter
P
D000368:Aged; D000375:Aging / Q000502:physiology; D001823:Body Composition / Q000502:physiology; D001842:Bone and Bones / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000139:chemically induced; D005298:Fertility / Q000502:physiology; D006321:Heart / Q000502:physiology; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity; D011467:Prostate / Q000187:drug effects; D011470:Prostatic Hyperplasia / Q000139:chemically induced; D011471:Prostatic Neoplasms / Q000139:chemically induced; D011788:Quality of Life; D013737:Testis / Q000502:physiology; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects / Q000172:deficiency / Q000502:physiology / Q000627:therapeutic use*
D013739:Testosterone