Abstract
Human aging is associated with many changes, which resemble those seen with deficiencies of sex steroids or growth hormone and with cortisol excess. Among these are decreases in lean body mass (LBM) and muscle strength, loss of bone mineral, increase in body fat, and, in men, reduced libido and erectile function. Circulating total and free testosterone (T) decrease progressively with age in men, and these decreases correlate with observed changes in body composition and function. T is implicated in maintaining both male libido and erectile function, the latter effect possibly mediated by local increases in nerve nitric oxide (NO) synthase in the corpora cavernosa. Preliminary studies of T replacement in older men suggest improvements in LBM, fat, bone, libido, and erections, but more research needs to be done to better delineate benefits and potential risks before definitive recommendations can be made regarding T replacement in older men.
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