In most men, serum testosterone concentrations decline steadily with age. Studies report that the total serum testosterone concentration of men at age 75 years is about two-thirds of the levels at age 25 years. Approximately 50% of men older than 80 years and about 20% of men older than 60 years have low serum testosterone concentrations. However, some men may go through a rather sudden change in testosterone levels. Signs and symptoms may include:
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weakness
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fatigue
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osteoporosis
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heart disease
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atherosclerosis
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irritability
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depression, anxiety
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metabolic syndrome
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slow wound healing
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reduced libido
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erectile dysfunction
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prostate problems
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low sperm counts
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reduced muscle mass
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disturbed sleep; insomnia
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impaired blood cell formation
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reduced cognitive function
The diagnosis of low testosterone levels (hypogonadism) is based on the presence of signs or symptoms and must be confirmed by laboratory testing, which should include Total Testosterone, Bioavailable Testosterone (Free plus Albumin Bound), Estradiol, Cholesterol, Prostate Specific Antigen (PSA), Complete Blood Count (CBC), Hemoglobin, and Hematocrit. A consensus statement by the International Society of Andrology, International Society for the Study of Aging Male, European Association of Urology, European Academy of Andrology, and American Society of Andrology, concluded that men with a serum concentration above 350 ng/dL generally do not require therapy, while men with serum testosterone concentrations below 230 ng/dL will usually benefit from testosterone replacement therapy (TRT).
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In older men, an optimal plasma testosterone level is associated with reduced all-cause mortality. When hormones are replaced or restored back to physiologic levels considered normal for younger males, men may experience a dramatic reversal of many signs and symptoms. Proper monitoring of laboratory values and clinical response are essential for optimal testosterone replacement therapy.
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Testosterone Replacement Therapy for men with low testosterone levels may produce a wide range of benefits including:
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improvement in libido and sexual function
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increased muscle mass and body composition
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increased strength and stature
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preservation of bone mass
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improvement in mood and depression
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enhanced cognition, concentration and memory
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improvement in sleep and quality of life
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reduced risk of developing type 2 diabetes mellitus and metabolic syndrome
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possible decrease in cardiovascular risk
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lower cholesterol and triglycerides
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lower blood glucose levels
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decrease visceral fat mass
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normalize blood clotting
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