This blog will be focused on some of the challenges we face in using androgens to maintain health. Undeniably, the quality of life of elderly men can be improved with androgen replacement. However, the use of androgens to maintain health, though very promising is less studied.
The challenges will be discussed in turn. To begin, one of the greatest challenges for the clinician is whether the “symptoms” of aging can be caused by low testosterone. In many cases, this is so as evidenced by reversal of symptoms with hormonal replacement. In other cases, it is less apparent, especially in the presence of multiple comorbidities. The astute diagnostician should able to decipher between low testosterone symptom complex and conditions such as anemia, depression, hypothyroidism, chronic disease states, side effects of medications and even psychological disorders. The second challenge is the reliability of screening instruments including the ADAM and the AMS. While sensitive, they lack specificity. The third challenge is the issue of whether fertility declines with aging and its relationship with androgens. The fourth challenge is the definition of low testosterone. Depending on whether one uses total, free or bioavailable testosterone, the prevalence differs. In addition, while standardization with laboratory values is desirable to make a diagnosis, could there be existence of relative hypogonadism? The fifth challenge is the choice of blood test. While arguably, the dialysis equilibrium for free testosterone is probably the gold standard, it is not widely available to clinicians. Age and obesity confound testosterone levels through its effects on SHBG. The sixth challenge is that saliva testing for hormones has been contemporary in some areas in the United States but its validity has not been well documented yet. The seventh challenge is that of late, there are propositions for the use of prohormones such as DHEA and even progesterone to slow the aging process. The main issue has been that while it is true that there are studies of association to prove the hypotheses, causal relationships are lacking, particularly in human models. The eight challenge is that of the role of estrogens in men. Undeniably, estrogens are important in men, such as for bone health and possibly the brain; but much is unknown at this point.
Some studies show an association with low testosterone and comordities such as depression, hip fractures and coronary artery occlusion. Also, some intervention studies show the positive effects on these comorbid states. If you are confused as to whether androgens can help you maintain health as you age, please do not hesitate to contact us at the Opal Medical Clinic or visit the web site www.opalmedical.com