Benefits and Risks of Testosterone Treatment of Older Men with Hypogonadism.

Total and free testosterone levels decline in men with advancing age due to defects at all levels of the hypothalamic-pituitary-testicular axis.

• The decline occurs at multiple levels of the hypothalamic-pituitary-testicular axis.
• Both total and free testosterone levels are affected by aging.
• This age-related decline forms the physiological basis for hypogonadism in older men.

Testosterone treatment of older men with low testosterone levels is associated with improvements in sexual function outcomes.

• Improvements were observed in sexual activity, sexual desire, and erectile function.
• These benefits were observed specifically in older men with low testosterone levels.
• Sexual function outcomes represent one of multiple domains of benefit identified in the review.

Testosterone treatment is associated with improvements in body composition and physical function.

• Benefits included improvements in lean body mass and muscle strength.
• Stair climbing power was also improved with testosterone treatment.
• Self-reported mobility was among the physical function outcomes that improved.

Testosterone treatment is associated with improvements in bone mineral density and estimated bone strength.

• Both areal and volumetric bone mineral density improved with testosterone treatment.
• Estimated bone strength was also improved.
• These skeletal benefits were observed in older men with low testosterone levels.

Testosterone treatment is associated with improvements in depressive symptoms and anemia.

• Depressive symptoms improved with testosterone treatment in older hypogonadal men.
• Anemia was also identified as a condition associated with improvement during testosterone treatment.
• These represent additional clinical domains of benefit beyond sexual function and physical outcomes.

Long-term risks of cardiovascular events and prostate cancer during testosterone treatment remain unknown.

• The paper explicitly identifies cardiovascular events and prostate cancer as risks with unknown long-term profiles.
• The uncertainty of long-term risks is a key consideration in treatment decisions.
• This uncertainty is explicitly acknowledged as a limitation in guiding clinical recommendations.

Testosterone treatment may be offered on an individualized basis to appropriately selected older men with hypogonadism.

• Treatment candidates should have 'unequivocally low testosterone levels' and 'symptoms or conditions associated with testosterone deficiency.'
• Treatment decisions should be made 'after consideration of potential benefits and risks, burden of symptoms, and patient's values.'
• The recommendation emphasizes an individualized rather than universal approach to treatment.