Health Articles

Male hypogonadism is not common in the elderly, with surveys suggesting a prevalence of less than 4%. Most cases in elderly men have no ready explanation and are associated with a combination of pituitary and testicular hyporesponsiveness. However, as shown in TABLE 69-1, hypogonadism is also caused by exposure to many drugs and toxins and by a number of illnesses.
Symptoms and Signs
Mild hypogonadism has few or very vague and nonspecific symptoms and no physical findings. Severe and prolonged hypogonadism leads to reduced skeletal muscle mass and the loss of body hair and masculine habitus. Small, soft testes and a loss of scrotal pigmentation and rugae are important clues.
Laboratory Findings
Leydig cell function may be estimated by a morning measurement of bioavailable (free) testosterone; a value < 67 ng/dL signifies hypogonadism. A total testosterone value of < 300 ng/dL is also diagnostic of hypogonadism, but the free fraction is more sensitive because of the increased binding of testosterone to sex hormone-binding globulin in the elderly. The level of luteinizing hormone is normal or low in almost all hypogonadal men. Dynamic testing with gonadotropin-releasing hormone adds little information, because the response is usually proportional to the basal luteinizing hormone level. A normal prolactin level helps exclude a pituitary tumor as the cause of hypogonadism.
Treatment
Hypogonadism is treated with androgen therapy. Long-acting esters of testosterone and 19-nortestosterone (the enanthate and the cyclopen-tylpropionate) are administered IM in a dose of 100 to 200 mg every 1 to 3 wk (usually as 100 mg each week, 200 mg every 2 wk, or 300 mg every 3 wk). Alternatively, oral forms of testosterone derivatives, which have an alkyl group in the 17 position, are usually prescribed as 5 to 50 mg/day of methyltestosterone (10 to 50 mg orally or 5 to 25 mg bucally). The IM formulations are generally preferred because the oral agents may cause hepatotoxicity with reversible elevation of hepatic enzymes, occasional episodes of cholestatic jaundice, and hepatic tumors. Sublingual forms of androgens may be safer than of'il forms.
Testosterone therapy restores muscle strength, bone density, hair pattern, libido, sense of well-being, and mood in severely hypogonadal men. Its effectiveness in the elderly is not usually as clear-cut as in younger men, and a 3-mo trial is recommended to identify benefits before either proposing long-term therapy or terminating treatment because it seems ineffective.
Therapy stimulates erythropoietin secretion, increasing the hematocrit. By enhancing activity of hepatic triglyceride lipase, it also reduces HDL cholesterol levels and increases sensitivity to the anticoagulant action of warfarin derivatives. Some degree of prostate growth and an increase in prostate-specific antigen (PSA) level liay occur, but development or exacerbation of obstructive symptoms is rare. Patients with elevated or borderline values of PSA probably should not be treated with androgens because of persistent, but unpn>Ved, concern that androgens promote the development of prostatic carcinoma. However, for many the benefit may outweigh the risk, so tb^t therapy may still be appropriate after careful consideration.

This entry was posted on Wednesday, July 25th, 2007 at 4:15 am and is filed under Male Hypogonadism and Impotence. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Male hypogonadism is not common in the elderly, with surveys suggesting a prevalence of less than 4%. Most cases in elderly men have no ready explanation and are associated with a combination of pituitary and testicular hyporesponsiveness. However, as shown in TABLE 69-1, hypogonadism is also caused by exposure to many drugs and toxins and by a number of illnesses.
Symptoms and Signs
Mild hypogonadism has few or very vague and nonspecific symptoms and no physical findings. Severe and prolonged hypogonadism leads to reduced skeletal muscle mass and the loss of body hair and masculine habitus. Small, soft testes and a loss of scrotal pigmentation and rugae are important clues.
Laboratory Findings
Leydig cell function may be estimated by a morning measurement of bioavailable (free) testosterone; a value < 67 ng/dL signifies hypogonadism. A total testosterone value of < 300 ng/dL is also diagnostic of hypogonadism, but the free fraction is more sensitive because of the increased binding of testosterone to sex hormone-binding globulin in the elderly. The level of luteinizing hormone is normal or low in almost all hypogonadal men. Dynamic testing with gonadotropin-releasing hormone adds little information, because the response is usually proportional to the basal luteinizing hormone level. A normal prolactin level helps exclude a pituitary tumor as the cause of hypogonadism.
Treatment
Hypogonadism is treated with androgen therapy. Long-acting esters of testosterone and 19-nortestosterone (the enanthate and the cyclopen-tylpropionate) are administered IM in a dose of 100 to 200 mg every 1 to 3 wk (usually as 100 mg each week, 200 mg every 2 wk, or 300 mg every 3 wk). Alternatively, oral forms of testosterone derivatives, which have an alkyl group in the 17 position, are usually prescribed as 5 to 50 mg/day of methyltestosterone (10 to 50 mg orally or 5 to 25 mg bucally). The IM formulations are generally preferred because the oral agents may cause hepatotoxicity with reversible elevation of hepatic enzymes, occasional episodes of cholestatic jaundice, and hepatic tumors. Sublingual forms of androgens may be safer than of'il forms.
Testosterone therapy restores muscle strength, bone density, hair pattern, libido, sense of well-being, and mood in severely hypogonadal men. Its effectiveness in the elderly is not usually as clear-cut as in younger men, and a 3-mo trial is recommended to identify benefits before either proposing long-term therapy or terminating treatment because it seems ineffective.
Therapy stimulates erythropoietin secretion, increasing the hematocrit. By enhancing activity of hepatic triglyceride lipase, it also reduces HDL cholesterol levels and increases sensitivity to the anticoagulant action of warfarin derivatives. Some degree of prostate growth and an increase in prostate-specific antigen (PSA) level liay occur, but development or exacerbation of obstructive symptoms is rare. Patients with elevated or borderline values of PSA probably should not be treated with androgens because of persistent, but unpn>Ved, concern that androgens promote the development of prostatic carcinoma. However, for many the benefit may outweigh the risk, so tb^t therapy may still be appropriate after careful consideration.

This entry was posted on Wednesday, July 25th, 2007 at 4:15 am and is filed under Male Hypogonadism and Impotence. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.