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The current status of therapy for symptomatic late-onset hypogonadism with transdermal testosterone gel

Ebert T, Jockenhovel F, Morales A, Shabsigh R. Eur Urol 2005;47:137-146

KEY WORDS: SLOH; Hypogonadism; Testosterone gel; Prostate; PSA; Erectile dysfunction; Osteoporosis

In contrast to the consequences of cessation of ovarian function in aging women, the clinical implications of decreasing androgen production in aging men are not unanimously accepted. The most pressing issues with symptomatic late-onset hypogonadism (SLOH) are diagnosis, treatment and monitoring.

• Testosterone therapy in men with LOH can significantly improve their sense of well-being, and lead to increases in muscle and bone mass, upper body strength, virility and libido. However, ensuring that optimal testosterone therapy is achieved in men with hypogonadism remains challenging.
• An important concern among clinicians is that testosterone therapy may cause or promote prostate cancer. While current evidence supports the safety of testosterone therapy, androgens are growth factors for pre-existing prostate cancer. Therefore, before therapy is initiated, careful digital rectal examination and determination of prostate specific antigen (PSA) in serum should be performed, in order to exclude evident or suspected prostate cancer. It is also important to monitor PSA levels every 3 months for the first year of treatment; thereafter, regular monitoring (mostly for prostate safety but also for cardiovascular and haematological safety) during therapy is mandatory.
• The ability of testosterone therapy to alleviate the signs and symptoms of SLOH, together with the development of convenient and active modes of administration, will lead to increased treatment of the aging male population. But evidence to establish the risks and benefits is still emerging and large-scale and long-term trials are needed.

See the abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15661407&dopt=Citation