24. Testosterone & Aging

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24. Testosterone & Aging

 

 

 

CATEGORY: Anabolic Steroids 100 Courses

COURSE NUMBER: 24

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Syllabus

EXECUTIVE SUMMARY 1

1 INTRODUCTION 11

Scope of this Report, 11

Aging and Hormonal Changes, 12

Testosterone, Human Development, and Health, 14

Measuring Testosterone Levels, 18

Testosterone Therapy, 18

Growing Use of Testosterone Therapy, 24

Clinical Trials, 27

Organization of the Report, 28

References, 28

2 TESTOSTERONE AND HEALTH OUTCOMES 32

Changes in Endogenous Testosterone Levels with Aging, 33

Literature Review, 39

Bone, 41

Body Composition and Strength, 47

Physical Function, 54

Cognitive Function, 58

Mood and Depression, 61

Sexual Function, 66

Health-Related Quality of Life, 72

Cardiovascular and Hematologic Outcomes, 73

Prostate Outcomes, 81

xiii

Other Health Outcomes, 93

Multiple Outcomes, 93

Summary, 99

References, 100

3 FUTURE RESEARCH DIRECTIONS 112

Strategy for Future Clinical Trials in Older Men, 113

Recommendations, 117

Initial Efficacy Trials in Older Men, 119

Protection of Research Participants, 137

Additional Areas of Research, 152

Recommendations, 152

References, 152

4 CONCLUDING REMARKS 159

Need for Efficacy Studies in Older Men, 159

Clinical Studies in Middle-Aged Men, 161

Summary, 163

References, 163

APPENDIXES

A Data Sources and Methods 165

B Randomized Placebo-Controlled Trials of Testosterone

Therapy in Older Men 173

C Additional Studies of Testosterone Therapy 182

D Testosterone Levels in Clinical Studies 198

E Acronyms 202

F Biographical Sketches of Committee Members and Staff 205

INDEX 211

Testosterone & Aging


Testosterone therapy: Potential benefits and risks as you age
Considering testosterone therapy to help you feel younger and more vigorous as you age? Know the risks before you make your decision.


The promise of testosterone therapy may seem enticing, but there are a lot of misconceptions about what the treatment can and can’t do for you. As you get older, testosterone therapy may sound like the ultimate anti-aging formula.


Yet the health benefits of testosterone therapy for age-related decline in testosterone aren’t as clear as they may seem. Find out what’s known — and not known — about testosterone therapy for normal aging.


What is testosterone?


Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men’s:
• Bone density
• Fat distribution
• Muscle strength and mass
• Facial and body hair
• Red blood cell production
• Sex drive
• Sperm production


What happens to testosterone levels with age?


Testosterone levels generally peak during adolescence and early adulthood. As you get older, your testosterone level gradually declines — typically about 1 percent a year after age 30 or 40. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease (hypogonadism).


Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles. Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches or gels.


Does a naturally declining testosterone level cause the signs and symptoms of aging?


Not necessarily. Men can experience many signs and symptoms as they age. Some may occur as a result of lower testosterone levels and can include:
• Changes in sexual function. This may include reduced sexual desire, fewer spontaneous erections — such as during sleep — and infertility.
• Changes in sleep patterns. Sometimes low testosterone causes insomnia or other sleep disturbances.
• Physical changes. Various physical changes are possible, including increased body fat, reduced muscle bulk and strength, and decreased bone density. Swollen or tender breasts (gynecomastia) and body hair loss are possible. You may have less energy than you used to.
• Emotional changes. Low testosterone may contribute to a decrease in motivation or self-confidence. You may feel sad or depressed, or have trouble concentrating or remembering things.


Some of these signs and symptoms can be caused by various underlying factors, including medication side effects, obstructive sleep apnea, thyroid problems, diabetes and depression. It’s also possible that these conditions may be the cause of low testosterone levels, and treatment of these problems may cause testosterone levels to rise. A blood test is the only way to diagnose a low testosterone level.


Can testosterone therapy promote youth and vitality?


Testosterone therapy can help reverse the effects of hypogonadism, but it’s unclear whether testosterone therapy would have any benefit for older men who are otherwise healthy.


Although some men believe that taking testosterone medications may help them feel younger and more vigorous as they age, few rigorous studies have examined testosterone therapy in men who have healthy testosterone levels. And some small studies have revealed mixed results. For example, in one study healthy men who took testosterone medications increased muscle mass but didn’t gain strength.


What are the risks of testosterone therapy for normal aging?


Testosterone therapy has various risks. For example, testosterone therapy may:
• Contribute to sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts
• Cause acne or other skin reactions
• Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer
• Enlarge breasts
• Limit sperm production or cause testicle shrinkage
• Increase the risk of a blood clot forming in a deep vein (deep vein thrombosis), which could break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism)
In addition, testosterone therapy may impact your risk of heart disease. Research has had conflicting results, so the exact risk isn’t clear yet.


Should you talk to your doctor about testosterone therapy?


If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits. Your doctor will likely measure your testosterone levels at least twice before discussing whether testosterone therapy is an option for you.


A medical condition that leads to an unusual decline in testosterone may be a reason to take supplemental testosterone. However, treating normal aging with testosterone therapy is not currently advisable.
Your doctor will also likely suggest natural ways to boost testosterone, such as losing weight and increasing muscle mass through resistance exercise.

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