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A Clinical Conundrum: The Diagnosis and Treatment of Androgen Deficiency in Older Men


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September 2007

Male hypogonadism is a condition in which the body produces little or none of the sex hormone testosterone. Most common signs and symptoms include negative effects on mood and cognition, diminished sexual function, osteoporosis, decrease in muscle mass, and loss of facial or body hair. This condition can be treated by testosterone replacement. As men age, however, it is difficult to differentiate true hypogonadism from the physiologic changes of normal aging. Testosterone-dependent diseases, such as benign or malignant prostate growth, become very common as men age so it is uncertain if administering testosterone to older men is beneficial and whether the risk/benefit ratio for testosterone replacement in older men is more difficult to define than it is in younger men. Various studies yield inconsistent results and hormone replacement is dependent upon the individual patient’s symptoms. However, measurement of total or bioabailable testosterone should be included in the workup of these patients.

A Practical Approach to the Patient with Subclinical Hypothyroidism

Subclinical hypothyroidism occurs when the serum thyroid-stimulating hormone (TSH) level rises above the upper limit of normal (ULN) despite a normal serum free thyroxine (FT4) concentration. Subclinical hypothyroidism, or mild thyroid failure, is a common problem with a prevalence of 4% to 8.5% in the adult population. The prevalence of subclinical hypothyroidism increases with advancing age and is higher in women than in men. Because serum TSH has a log-linear relationship with circulating thyroid hormone levels (e.g., a 2-fold change in FT4 produces a 100-fold change in TSH), it is the key test for the diagnosis of subclinical hypothyroidism.

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