ABSTRACT
As described in earlier sections, total and free testosterone levels decrease with age (please refer to Chapter 12). This decline in Leydig cell function occurs at a time when various androgen-responsive end organs show signs of abnormal function (i.e., penis, bone, and muscle). Although a decrease in sexual function is often observed in older men, many aged men have other causes for erectile dysfunction (ED), and thus do not experience a reversal of impotence when treated with testosterone alone. Combined PDE-5 inhibitors and testosterone may be beneficial on sexual function when decreased libido and ED are present in hypogonadal, older men. Although it has not been proved that androgen therapy in older men with borderline or normal range testosterone levels will improve sexual function, prevent bone and muscle loss, or improve the quality of life (4-7), clinical trials are underway to determine its efficacy in symptomatic men with definitely low serum testosterone levels. The possible beneficial effect of androgens must be balanced against the possible adverse effects on lipids, prostate, and sleep-related breathing disorders (7-9).
