There is a slow decline in testosterone (T) levels in most men as they age even without the disease. The reduction of T levels has proved to cause alterations of body composition, diminishing energy, muscle strength, cognition, sexual function, and depressed mood. The Leydig cells differentiate to produce Testosterone and are regulated by luteinizing hormone (LH). When the t levels decline in aged men the Luteinizing Hormone levels to not change at all hence the conclusion that T levels are nor as a result of reduced Luteinizing Hormone levels but the decrease in the ability of the LH to stimulate testicular production of T. Testosterone when given to older men results to symptoms like irritability, fatigue, erectile problems, and low libido. This is called t therapy that aims at testosterone resurgence. Today, the decline in T levels can be measured and the appropriate therapy and treatment regimens selected for them.
Hypogonadism in aging men
First, there is uncertainty on determining which old men require Testosterone resurgence therapy, how to define T deficiency, and what cut-off to use to decide that T level is low. Selecting a T component to use is also a problem since using the bioavailable T components does not give the accurate total T levels. Measurements from bioavailable components will lead to the diagnosis of several old men as T deficient. Best practice guidelines recommend that t measurements should be the Total T level and if found to be in a low range the measurement should be accompanied by the bioavailable T component measurement.
Clinical assays lack accuracy, sensitivity, and precision since there is no range to use for reference. It is hard to decide that an old man has a low range of testosterone even though there is a range considered normal from the T assays of a young adult male.t deficiency is currently diagnosed using the signs and symptoms of T deficiency. This method is not accurate since T decline affects many organs. The T therapy results are observed from the improvement of the symptoms after T replacement. Furthermore, the symptoms are not specific to hypogonadism. None of the screening diagnoses have proved to be specific and there is a need to develop a better screening tool.
Older men with normal T levels are asymptomatic while those with lower levels are symptomatic. Some T deficiency symptoms such as sexual dysfunction and fatigue are more evident in older men with low T levels. T therapy in young men greatly improves their T levels. If older men have active T response, then T replacement therapy can show some possible benefits in the treatment of the symptoms. However, there is no data to prove that T therapy in older men has substantial benefits or avoids harm to men with low T levels. Studies investigating the effect T therapy has on older men showed that it leads to an increase in skeletal muscle mass hence the assumption that it improves muscle strength.
T therapy has also proved to increase bone mineral density in therapy targeting androgen target organs. The replacement therapy however has no evidence on the effects on depression, quality of life, and cognition in older men. The T resurgent therapy also has potential risks such as liver function abnormalities and aggressive mood which are controllable and are monitored.
T replacement therapy in older veterans showed a decrease in the mortality rate compared to no treatment and for older men with heart failure, the therapy increased their exercise capacity. The prostrate risks have not been proved yet through ant clinical trial and will require a minimum of 6000 older men to acquire efficient date.
Some working used T replacement methods are.
· Use of injectable esters
· Use of implantable pellets every three months
· Oral T undecanoate taken frequently during the day
· Use of scrotal patch, transdermal patch, and transdermal gel.
· Injection of T undecanoate
· Matrix patch
Due to little available evidence and research work, there are various loopholes in the knowledge of hormone replacement therapy. The benefits of T therapy also need to be studied to be certain about the effects of T therapy administration.