How to help the aging male? Current approaches to hypogonadism in primary care

Abstract

Hypogonadism is a common condition which occurs more frequently in older men. It is characterized by low testosterone (T) and is associated with symptoms which are often nonspecific. A key symptom is low libido, but it can also be associated with erectile dysfunction, reduced muscle mass and strength, increased body fat, reduced bone mineral density and osteoporosis, reduced vitality, and depressed mood. Hypogonadism is linked with a variety of comorbid conditions including erectile dysfunction, metabolic syndrome, diabetes, obesity, and osteoporosis. However, the condition is often underdiagnosed. T supplementation in hypogonadism is associated with a range of benefits including improved sexual function, increased lean body mass and/or reduced fat mass, and improved bone mineral density. A variety of T supplementation formulations are available. Although there is no evidence of increased risk of initiating prostate cancer with T supplementation, it is contraindicated in men with prostate cancer. It is important that primary care physicians are aware of both the signs and symptoms of hypogonadism, the monitoring and testing that is required and the merits and advantages of the various T preparations to ensure optimal management of the condition with a treatment approach that best suits patients’ needs.

Keywords::

• Hypogonadism
• late-onset hypogonadism
• testosterone deficiency
• testosterone supplementation

Acknowledgment

Medical writing assistance (funded by Ferring Pharmaceuticals) was provided by Tom Lavelle of Bioscript Stirling Ltd. The authors participated in an Advisory Board meeting on testosterone replacement therapy. The meeting was sponsored by Ferring Pharmaceuticals and attendees received an honorarium for their participation in the meeting. The concept for this review paper arose from discussions during the meeting.

Declaration of Interest: Stefan Arver has also consulted as a medical expert for Bayer AG, Ely Lilly, Pfizer Inc., AstraZeneca AB, KaroBio AB, Ferring and lectured in curricula supported by these corporations and also received grants for investigator initiated studies from Bayer. Ignacio Moncada, D. Aled Rees, Heinrich M. Schulte and Bruno Lunenfeld report no conflicts of interest.