The Aging Male

o With the World-wide increase in life expectancy there has been a long waited revival of interest in the well being of elderly men (Healthy Aging).

Male Aging is known to be associated with:
o Chronic diseases ( hypertension, diabetes etc,..)
o Erectile dysfunction
o BPH & prostate cancer
o Age related testosterone deficiency & it's associated clinical symptoms.

PADAM
Partial Androgen deficiency in Aging Men

ـ No discontinuation in reproductive life
ـ Very Gradual decline of androgen levels (1% / year after the age of 40)

PADAM - Mechanisms
o Partial androgen deficiency in the blood.
o Decreased receptor sensitivity to testosterone or its active metabolites in target tissues.

Mechanisms of Androgen Deficiency
o Decreased Pituitary surges of LH.
o Reduced Leydig cell mass & function.
o Increased peripheral conversion of androgens to estrogens by the aromatase enzyme in adipocytes.

Hormonal Changes - Male
o Total, Free & bioavailable (T) gradually decrease after the age of 40.
o SHBG gradually increase.
o Prolactin slightly increase.
o Attenuation of Testosterone circadian rhythm in elderly men.



PADAM
Clinical Presentation
o Altered state of well being
o Decline of physical energy & strength
o Sexual dysfunction (Libido, ED)
o Deleterious effects on muscle mass, bone density, lipid profile & cognitive functions
o Nervousness, hot flushes & sleep disorders



Testosterone Replacement Therapy

Treatment Recommendations
Androgen Replacement Therapy

o Ideally hypogonadism is diagnosed by a low level of bioavailable testosterone.
o Androgen deficiency requires long term replacement therapy.
o Hypothalamic-pituitary failure should be fully investigated.
o BPH is a relative contraindication depending on severity of obstructive symptoms
o Prostate cancer is an absolute contraindication. Check for PSA and perform digital rectal exam before initiating therapy in men older than 40.
o Oral testosterone undecanoate, IM oil-based testosterone & Testosterone patches are preferable.
o 17-Alkylated steroids have a hepatotoxic potential.
o F/U Hematocrit, lipid profile & PSA q 6 months.

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