ABSTRACT
The field of hormonal alterations in the aging male has attracted the interest of the medical community and the public at large. The potential role of hormone replacement in the aging male is still a matter of debate and it will take many more years before hormone replacement therapy (HRT) will find its proper definitive place. It requires large-scale longterm studies, which are difficult to fund and execute but are in the planning stage. Apart from that, the attitude towards hormone replacement in the elderly has changed following the publication of the outcome of HRT in postmenopausal women of the Women Health Initiative study, which found an excess of breast cancer and cardiovascular disease in the treatment group versus placebo.1 Even though many methodologic questions still await answers, the approach to postmenopausal HRT has become more critical.2 The approach to HRT in aging men has always been more cautionary than to HRT in women, and the outcome of the Women Health Initiative study has added to this.1,3 It is further recognized that the endocrinologic changes associated with aging, in both men and women, are not limited to sex hormones alone. Indeed, profound
changes occur in other hormones such as growth hormone, dehydroepiandrosterone (DHEA), melatonin, while insulin levels tend to rise with aging. Plasma cortisol levels do not fall but the ratio to the catabolic corticosteroids to the anabolic androgens increases, with potentially deleterious effects. In patients receiving glucocorticoid treatment, simultaneous administration of testosterone appeared to ameliorate the catabolic effects of glucocorticoids on bone and muscle.4
