ABSTRACT
There is an increasing interest in the use of testosterone replacement therapy (TRT) for lateonset hypogonadism (LOH). Mean testosterone values can decline by as much as 50% between the ages of 25 and 75.1 This results in 20% of men being androgen-deficient by the age of 60, increasing to 40% by the age of 80 (Fig. 16.1).2 Clinically, this can lead to symptoms, including fatigue, depression, impaired memory, poor concentration, and loss of muscle mass and sexual vigor.3 TRT has been found to be of use in decreasing the severity of these symptoms;4 however, there remain considerable concerns regarding the potential long-term effect of such treatment, particularly on the prostate. Concerns about TRT on the prostate stem from knowledge that medical or surgical castration in prostate cancer patients can lead to delayed disease progression, at least initially. Therefore, it has been suggested that increasing testosterone could lead to an over-expression of prostate cancer or other prostate-related diseases such as benign prostate hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS).
