Potential benefits

From the discussion in the preceding sections of this chapter and from literature reviews (Bhasin and Buckwalter 2001; Gruenewald and Matsumoto 2003), it emerges that testosterone administration to elderly men can induce potentially beneficial effects, but the results are often mitigated and there usually is no demonstrated impact on endpoints that are directly relevant for the clinic. Several studies have shown improvement of lean body mass and sometimes also of muscle strength, but whether these changes are sufficient to make a difference in terms of functionality is still unclear. Positive effects on bone mineral density are seen only in men with frankly low serum testosterone and we have no information on the effect of treatment on fracture rates. Abdominal fat may decrease and the insulin sensitivity may improve, whereas high dose testosterone may have direct beneficial effects on heart and arteries, but we have no indication of gains in terms of hard cardiovascular endpoints. There have been reports of favorable effects on mood, cognition an general well being, but the findings are not always consistent and we have no data indicating that treatment may prevent or help treat depression, or have substantial longer-term effects on cognition and quality of life. Sexual functioning can improve, but the treatment effects are rather small and usually significant for only a few of the several assessed indices of sexual function.

A major limitation is the scarcity of controlled data available. No more than a few hundred elderly men in total have been included in controlled trials and among these we have counted a total of only 275 men included in a trial of at least one year duration; less than half these men received active treatment with testosterone. Moreover, a majority of trials have included a substantial proportion of elderly men with initially (low) normal serum testosterone.

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