Abstract
There is indisputable evidence that advancing age is associated with a decline in the production of several hormones. The most prominent alterations are related to the sex steroids, but other hormones such as growth hormone and melatonin are also profundly affected. The clinical syndrome of androgen decline in the aging male, or andropause, has been described, but a direct causality between its manifestations and the alterations in a specific hormone is not yet fully established.Concerns exist about the effect of exogenous androgens in various organ systems. The most serious refer to the prostate in general and the development of carcinoma in particular. Current evidence indicates that, with the exception of severe lower urinary tract obstructive symptoms or prostate cancer, the use of androgens is safe. However, experience with chronic androgen administration in the elderly is still limited and caution is needed. Prostate assessment by digital rectal examination and measurement of prostate-specific antigen are mandatory prior to and during treatment. Careful, long-term monitoring must be a serious commitment by both the patient and the physician. A set of general recommendations for androgen supplementation in the aging male is included, with emphasis on prostate safety issues regarding lower urinary tract obstructive symptoms and prostate cancer.
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