Androgens in Health and Disease.pdf - E Library

360 Tenover
Laboratory tests should include a serum T level, hemoglobin and hematocrit, and a PSA.
In the absence of obvious problems, a trial of ART should last for at least 6 mo, because
it often takes that amount of time to differentiate true benefits of therapy from placebo
effects. This necessitates a second follow-up visit for monitoring at about mo 6 of
treatment. If the treatment is felt to have been efficacious and no significant adverse
events have arisen, the therapy can be continued, but it should be reassessed at least on
a yearly basis.
CONCLUSION
The potential rejuvenation of certain functions in aging men through treatment with
a testicular “invigorating agent” is not a new concept. Studies involving ART date back
to the late 19th century with Brown-Séquard’s self-experimentation using animal testicular
extracts (96). Since the 1930s, when T was synthesized, a great deal has been
learned about its physiology and clinical effects. Yet, there remains a lack of both solid
clinical data to define which older men are good candidates to receive ART and consensus
guidelines on how to diagnose and treatment PADAM. The data that are available
give support to the hypothesis that ART should have a number of beneficial effects for
some older men and that its adverse effects may not be so severe as to overwhelm
efficacy. Until such time as more clinical data on ART are forthcoming, especially data
as relates to effects on the development of fractures, cardiovascular events, LUTS caused
by BPH, and prostate cancer, it is important to continually reassess the benefits and risks
of ART therapy for each man.
REFERENCES
1. Vermeulen A. Clinical Review 24: Androgens in the aging male. J Clin Endocrinol Metab
1991;73:221–224.
2. Gray A, Berlin JA, McKinlay JB, Longcope C. An examination of research design effects on the association
of testosterone and male aging: results of a meta-analysis. J Clin Epidemiol 1991;44:671–684.
3. Deslypere JP, Vermeulen A. Leydig cell function in normal men: effect of age, life-style, residence,
diet and activity. J Clin Endocrinol Metab 1984;59:955–962.
4. Ferrini RL, Barrett-Connor E. Sex hormones and age: a cross-sectional study of testosterone and estradiol
and their bioavailable fractions in community-dwelling men. Am J Epidemiol 1998;147:750–754.
5. Gray A, Feldman HA, McKinlay JB, Longcope C. Age, disease, and changing sex hormone levels in
middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab 1991;73:
1016–1025.
6. Morley JE, Kaiser FE, Perry HM, et al. Longitudinal changes in testosterone, luteinizing hormone, and
follicle stimulating hormone in healthy older men. Metabolism 1997;46:410–413.
7. Znuda JM, Cauley JA, Kriska A, et al. Longitudinal relation between endogenous testosterone and
cardiovascular disease risk factors in middle-aged men: a 13-year follow-up of former Multiple Risk
Factor Intervention Trial participants. Am J Epidemiol 1997;146:609–617.
8. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum
total and free testosterone levels in healthy men. J Clin Endocrinol Metab 2001;86:724–731.
9. Perry HM, Miller DK, Patrick P, Morley JE. Testosterone and leptin in older African-American men:
relationship to age, strength, function, and season. Metabolism 2000;49:1085–1091.
10. Usanachitt C, Leepipatpaiboon AAS, Numchaisrika P. Relationship of male hormonal levels and
aging in Thai males. Aging Male 2000;3(Suppl 1):47.
11. Geller J, Albert J, Lopez D, et al. Comparison of androgen metabolites in benign prostatic hypertrophy
(BPH) and normal prostate. J Clin Endocrinol Metab 1976;43:686–690.
12. Harman SM, Tsitouras PD. Reproductive hormones in aging men. I. Measurement of sex steroids,
basal luteinizing hormone, and leydig cell response to human chorionic gonadotropin. J Clin Endocrinol
Metab 1980;51:35–40.