Options of androgen treatment in the aging male

Abstract

It is now well documented that bioavailable androgen levels fall with aging. Results of the first studies investigating (Side-) effects of androgen administration to aging men are encouraging. The introduction of designer estrogens as a treatment modality in hormone replacement in women has invited consideration of the concept of compounds with selective androgenic effects for male hormone replacement therapy in general. The full spectrum of the actions of testosterone may not be necessary or even undesired for androgen treatment of the aging male. To define those indications for which certain androgenic properties are desired and undesired, more insight into basic androgen (patho)physiology is required. There is convincing evidence that aromatization of androgenic compounds to estrogens might be an advantage for maintenance of bone mass, and might also mitigate negative effects of androgens on biochemical parameters of cardiovascular risks.

The psychotropic effects of androgens may also require aromatization. The potentially negative effects of estrogens on prostate pathology in aging men needs further elucidation. While the role of dihydrotestosterone (DHT) in male sexual differentiation and in pubertal sexual maturation is evident, its role in mature and aging males seems less significant or may even be hannful. It is of note, however, that a negative effect of DHT on prostate pathophysiology is certainly not proven. For most of the androgenic actions, the critical levels of androgens are not well established. This is relevant, as the large amount of androgen molecules required for biological actions (compared to estrogens) is an impediment in androgen replacement modalities. There may be room for more biopotent androgens, as delivery of large amounts of androgen molecules to the circulation poses problems for treatment modalities.

Key Words:

• AGING
• ANDROGENS
• SYNTHETIC ANDROGENS
• DESIGNER DRUGS