Androgens in Health and Disease.pdf - E Library

Chapter 18/Androgens in Older Men 355
have a positive impact on function has been the study of relatively healthy men using
function measures that are insensitive or have “ceiling effects.” The increases in muscle
strength that occur with ART may have more of a clinical impact on function when
evaluated with different measures or when used in men who are more frail at baseline.
In this regard, it should be noted that the one study to date that has demonstrated an
improvement in function with ART used the treatment in men who were not robust (83).
ART and CVD Risk
Studies on the cardiovascular effects of ART in older men have been done by evaluating
the response of various CVD risk factors to treatment. As has been shown with
female HRT, this may not be the most clinically accurate way to assess true CV benefits
and/or risks. Nonetheless, until there are long-term large multicenter trials of ART in
which clinical CV end points, such as myocardial infarction or stroke, are assessed, this
is the best method and these are the best data available.
In terms of changes in cholesterol profiles with ART, the effects generally appear to
be beneficial (see Table 5). Blood pressure has not been reported to increase in any of
the ART studies, even though there is transient increase in body weight that is assumed
to be the result of fluid retention. None of the ART trials to date has measured the effects
of treatment on vasoactive factors.
ART and Libido and Mood
Studies in older men with low libido have generally reported an improvement in libido
and sexual arousal with therapy (52,89). There have been a few blinded placebo-controlled
studies involving ART that have included evaluation of mood using self-report
questionnaires with graded scales for items such as energy or general well-being (76,85).
In these studies, men on androgen therapy reported increased energy levels and sense of
well-being compared to that reported on placebo therapy.
ART and Cognition
There have been only a few small clinical trials of ART and its effects on cognitive
function in older men. Several studies reported an effect on visual spatial memory
(59,90); another study showed no effects on tested memory (87). Several other studies,
which have been reported in abstract form only, have reported improvement in trailmaking
ability and spatial and verbal memory with T.
ART and Polycythemia
Most studies of ART have reported a significant increase in hemoglobin and hematocrit
levels with therapy (see Table 6) (76,77,79,81,84,87,89,91,92). The increases
reported are much larger than those usually seen with T treatment in younger hypogonadal
adult men. Because older men tend to have slightly lower hematocrits than do young
adult men, the increase in hemoglobin and hematocrit may be beneficial in some men.
It is possible that it is this increase in oxygen-carrying capacity that contributes, in part,
to the decrease in fatigue and improved energy levels reported by some men on ART. In
some cases, however, the increases in hematocrit have necessitated termination in
therapy, phlebotomy, or a decrease in the T dose. Although the coexistence of sleep
apnea and elevated body mass index may contribute to the development of polycythemia,
these have not been contributing factors in most cases. The method of T replacement may