The average age of men in the US is projected to rise significantly over the next 25 years, with the greatest increase occurring in men > 65 years old.

As this happens, there will be a dramatic increase in age-related health problems too, including cancer, strokes, heart disease and hormone deficiency. Although the health risks associated with age-related hormonal decline in women, termed menopause, have been thoroughly addressed, it has now been shown that hormonal changes in the aging male are associated with significant health problems.

Specialty board certified Dr. Paul Turek at The Turek Clinic, a Best Doctors in America choice for 7 years running, has expertise and interest in helping patients understand all of the issues, good and bad, that surround testosterone replacement therapy in men of all ages.

To learn more about male hormone replacement, please select one of the following topics. If you are ready to schedule a consultation with Dr. Turek, please request a consultation here.

There is a progressive decline in testosterone production in men with age. These changes can be dramatic, such that 50% of men >60 years old have low levels of testosterone. Although the rate of decline varies widely, a general rule of thumb is that testosterone levels decrease about 1% yearly after age 50. Despite the fact that it is not as rapid a drop in hormones as women get with menopause, it certainly is just as real. This has been termed male menopause, male climacteric, andropause, or more appropriately, partial androgen deficiency in the aging male (PADAM). Serum testosterone levels in men fall progressively from the third decade to the end of life, mainly due to a decline in the cells in the testis that make the hormone (Leydig cells). This decline may also be due to changes in hormones (GnRH, LH) and proteins (SHBG, albumin) that regulate testosterone production.

One issue with testosterone that complicates matters is the fact that it exists in several different forms in the blood, and each form has different hormonal activity (Figure 1). Free or unbound testosterone is a fully active hormone, but protein-bound testosterone are only partly active, or sometimes completely inactive. What is usually measured in a blood draw is the total testosterone, which is a combination of the free and protein-bound forms. An analogy to explain this is to think of the total testosterone as all of the cars in a parking lot.

Importantly, though, only the cars that can start or drive are useful or active. Free testosterone comprises all of the cars that can start and be driven away, but the protein-bound testosterone are those cars that may or may not start, and those that may or may not be able to be driven away. So, aging is associated with 1) lower total testosterone production (fewer cars in the lot) and 2) higher levels of certain proteins that bind testosterone (sex hormone-binding globulin, SHBG), such that even fewer cars can start and run, and it is this combination of events that leads to declining testosterone activity with age. Thus, the complex physiology of testosterone balance often clouds the interpretation of age-related declining levels of the hormone.

Testosterone affects the function of many organs in the body (Table 1). In the brain, it influences libido or sex drive, male aggression, mood and thinking. Testosterone can improve verbal memory and visual-spatial skills. It as also been shown to decrease fatigue and depression in men with low levels. It is responsible for muscle strength and growth, and stimulates stem cells and blood cells in bones and kidneys. Penile growth, erections, sperm production, and prostatic growth and function all depend on testosterone. It also causes body hair growth, balding, and drives beard growth. Thus, testosterone makes us who we are, and influences how we look.

In men with low testosterone levels, testosterone can improve bone mineral density and reduce bone fractures, an effect similar to that found in postmenopausal women on estrogen replacement. Importantly, hip fractures are 2-3 times as likely to kill an older man as a woman of the same age, and 40% of older male patients with hip fractures die within 1 year of the injury.

Testosterone results in increases in lean body mass, possibly strength and can decrease fat mass. By stimulating erythropoietin, testosterone increases blood counts. It appears to improve lipid profiles and dilates blood vessels in the heart but no data has yet shown that it reduces heart attacks or strokes. It appears not to alter LDL or total cholesterol levels. In recent work, it has been shown that men with chronically low testosterone levels have 2-3 fold higher risk of developing metabolic syndrome and have up to a 40% greater risk of death than men with normal testosterone levels.

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Male Hormone Replacement - Testosterone - The Turek Clinic

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