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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:M382-M383 (2003)
© 2003 The Gerontological Society of America

LETTER TO THE EDITOR

KNOWLEDGE ABOUT LOW TESTOSTERONE IN OLDER MEN

Syed H. Tariq, MD

Division of Geriatric Medicine Saint Louis University and Geriatric Research Education and Clinical Center Veterans Affairs Medical Center Saint Louis, MissouriE-mail: tariqsh{at}slu.edu

To the Editor:

While I enjoyed the paper by Anderson and colleagues (1), I must respectfully disagree with their conclusion that health care professionals and the general public are knowledgeable about low testosterone in older men. Hypogonadism in older men is very common (2–4), and yet only a very small proportion of hypogonadal men in the United States are currently receiving treatment.

The type of hypogonadism found in older men is usually a result of aging (5) associated with sarcopenia (4,6,7), bone mineral density (8), memory disturbance (9), and functional decline (10). It also may be a major factor in the pathogenesis of anorexia (11). Treatment increases muscle mass (12), muscle strength (13), and cognition in some, but not all, studies (13,14). Testosterone decline also has been associated with accelerated arteriosclerosis in older men (15). Recently it has been shown that testosterone replacement tends to improve function in older men undergoing rehabilitation (16). All of these findings suggest that testosterone may play a major role in the pathogenesis of frailty in older men (17–21).

The Journal, in recent editorials (22,23) and in an in-depth review article (24), has strongly recommended that awareness of andropause be increased and, where appropriate, treated. It is important to recognize that the diagnosis should be made first by identifying the presence of symptoms utilizing a formal testing instrument such as Saint Louis University's Androgen Deficiency in Aging Males (25). When symptoms are present, the diagnosis is confirmed by measuring bioavailable testosterone. A total testosterone will fail to identify a large number of hypogonadal men (26).

Thus, I believe that the appropriate conclusion of the article by Anderson and colleagues (1) should have been that there is a major need for nationwide education on the existence of andropause and its appropriate diagnosis and treatment.

REFERENCES

  1. Anderson JK, Faulkner S. Cranor C, et al. Andropause: knowledge and perception among the general population and health care professionals. J Gerontol Med Sci.. 2002;57A:M793-M796.[Abstract/Free Full Text]
  2. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Baltimore Longitudinal Study of Aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metabol.. 2001;86:724-731.[Abstract/Free Full Text]
  3. Morley JE. Androgens and aging. Maturitas.. 2001;38:61-7171-73.
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  5. Kenny AM, Prestwood KM, Gruman CA, et al. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels. J Gerontol Med Sci.. 2001;56:M266-M272.[Abstract/Free Full Text]
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  7. Iannuzzi-Sucich M, Prestwood KM. Kenny AM. Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy older men and women. J Gerontol Med Sci.. 2002;57A:M772-M777.[Abstract/Free Full Text]
  8. Christmas C, O'Connor KG. Harman SM, et al. Growth hormone and sex steroid effects on bone metabolism and bone mineral density in healthy aged women and men. J Gerontol Med Sci.. 2002;57:M12-M18.[Abstract/Free Full Text]
  9. Morley JE, Kaiser F. Raum WJ, et al. Potentially predictive and manipulatable blood serum correlates of aging in the healthy human male—progressive decreases in bioavailable testosterone, dehydroepiandrosterone sulfate, and the ratio of insulin-like growth factor 1 to growth hormone. Proc Natl Acad Sci U S A.. 1997;94:7537-7542.[Abstract/Free Full Text]
  10. Perry HM, 3rd, Miller DK, Patrick P, Morley JE. Testosterone and leptin in older African-American men: relationship to age, strength, function, and season. Metab Clin Exp.. 2000;49:1085-1091.
  11. Morley JE. Decreased food intake with aging. J Gerontol Med Sci.. 2001;56A:M81-M88.
  12. Sih R, Morley JE, Kaiser FE, Perry HM, 3rd, Patrick P, Ross C. Testosterone replacement in older hypogonadal men: a 12-month randomized controlled trial. J Clin Endocrinol Metab.. 1997;82:1661-1667.[Abstract/Free Full Text]
  13. Kenny AM, Bellantonio S, Gruman CA, Acosta RD, Prestwood KM. Effects of transdermal testosterone on cognitive function and health perception in older men with low bioavailable testosterone levels. J Gerontol Med Sci.. 2002;57:M321-M325.[Abstract/Free Full Text]
  14. Cherrier MM, Asthana S, Plymate S, et al. Testosterone supplementation improves spatial and verbal memory in healthy older men. Neurology.. 2001;57:80-88.[Abstract/Free Full Text]
  15. Kenny AM, Prestwood KM, Gruman CA, Fabregas G, Biskup B, Mansoor G. Effects of transdermal testosterone on lipids and vascular reactivity in older men with low bioavailable testosterone levels. J Gerontol Med Sci.. 2002;57:M460-M465.[Abstract/Free Full Text]
  16. Bakhshi V, Elliott M, Gentili A, Godschalk M, Mulligan T. Testosterone improves rehabilitation outcomes in ill older men [Comment]. J Am Geriatr Soc.. 2000;48:550-553.[Medline]
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  18. Morley JE. Perry HM 3rd, Miller DK. Editorial. Something about frailty. J Gerontol Med Sci.. 2002;57:M698-M704.[Free Full Text]
  19. Lipsitz LA. Dynamics of stability: the physiologic basis of functional health and frailty. J Gerontol Biol Sci.. 2002;57:B115-B125.[Abstract/Free Full Text]
  20. Gillick M. Pinning down frailty [Comment]. J Gerontol Med Sci.. 2001;56:M134-M135.[Free Full Text]
  21. Fried LP, Tangen CM. Walston J, et al. [Cardiovascular Health Study Collaborative Research Group]. Frailty in older adults: evidence for a phenotype. J Gerontol Med Sci.. 2001;56:M146-M156.
  22. Morley JE. Drugs, aging, and the future. J Gerontol Med Sci.. 2002;57:M2-M6.[Free Full Text]
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  25. Morley JE, Charlton E, Patrick P, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metab Clin Exp.. 2000;49:1239-1242.
  26. Morley JE, Patrick P, Perry HM. Evaluation of assays available to measure free testosterone. Metab Clin Exp.. 2002;51:554-559.




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