ABSTRACT
The rapid increase in the aging population has brought new challenges and new solutions to the forefront of medical practice. It is a long and well-established fact that there are significant endocrinologic alterations (Table 21.1) associated with the aging process.1,2 This has created a need for exploring issues related to hormonal supplementation in aging men. With the notable exception of thyroid replacement, the treatment of the remaining deficiencies is mired in controversy; which is particularly intense around androgen substitution. From the outset it should be established that there are four
basic notions that require awareness when discussing the use of androgen replacement therapy (ART) in men. The first and most fundamental one is that the patient must have documented and symptomatic hypogonadism. In the same manner that a man with benign prostatic hyperplasia (BPH), another condition associated with aging, but without obstructive symptoms is, normally, not a candidate for treatment, a man with low or borderlinelow serum level of testosterone and no manifestations of hypogonadism does not necessarily require treatment (Figure 21.1). Second, there should be no specific contraindications for ART. Third, the treating physician must be familiar and comfortable with his/her ability to diagnose and treat the condition. Finally, and perhaps most importantly, both the physician and the patient
must commit to a regular follow-up schedule to assess the therapeutic response and potential adverse effects developing as a consequence of treatment. At present there is a wide and ever increasing choice of treatments for symptomatic late onset hypogonadism (SLOH).
