Temporal trends in testosterone levels and treatment in  older men.
OBJECTIVE
Longitudinal studies of testosterone concentrations have yielded sharper estimates of age-related androgen declines than their cross-sectional counterparts. A potential explanation for this phenomenon is a secular (age independent) mechanism acting to accelerate within-individual testosterone decreases with time. This article reviews the evidence in favor of such secular trends and discusses potential causes and implications.


RESULTS
The magnitude of the proposed secular trend may be as much as 1% per calendar year in excess of per year cross-sectional trends. Current evidence suggests that body composition changes as expressed by BMI can in part account for the trend in testosterone. More speculative recent findings suggest a potential contributory role for environmental endocrine disruptors, but to date no longitudinal studies have examined this question. Symptomatic androgen deficiency as currently defined is associated with diverse downstream morbidity, but may not constitute a robust designation over longer term periods of time. Information concerning treatment patterns in the general population is limited.


CONCLUSIONS
Existing evidence, though limited, supports the hypothesis of secular declines in serum testosterone levels in adult men. It is conceivable that these trends may influence the health of the public. Studies confirming and accounting for these trends are needed.
Travison
Thomas G
TG
New England Research Institutes, Watertown, Massachusetts 02472, USA. ttravison@neriscience.com
Araujo
Andre B
AB
Hall
Susan A
SA
McKinlay
John B
JB
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood*; D000728:Androgens / Q000627:therapeutic use*; D015992:Body Mass Index; D015536:Down-Regulation; D019317:Evidence-Based Medicine; D020249:Hormone Replacement Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood* / Q000172:deficiency / Q000627:therapeutic use*
D000728:Androgens; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone