Androgens in the Aging Male

The RxFiles

May-June 2003

What the world needs is a little more testosterone!

Hormones and Aging

• Females– sudden drop

• Males– gradual decline

Androgen Deficiency Symptoms

Do you have a decrease in libido (sex drive)? *

Do you have a lack of energy?

Do you have a decrease in strength and/or endurance?

Have you lost height?

Have you noticed a decreased "enjoyment of life?"

Are you sad and/or grumpy?

Are your erections less strong? *

Have you noticed a recent deterioration in your ability to play sports?

Are you falling asleep after dinner?

Has there been a recent deterioration in your work performance?

ADAM or Morley Questionaire

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Morley Questionnaire

• 10 questions every middle aged man is afraid to ask

• 88% sensitivity for low BT– catches most

• 60% specificity for low BT– catches many (~40%) who should not be caught

• multifactorial nature of symptoms

• natural course of aging

• other medical conditions

Testosterone by System

• Brain– libido, depression, irritable, concentration

• Body– abdominal obesity, muscle & strength, hair

regression, BMD, gynecomastia

• Genitourinary– smaller, softer, impotence

• General– fatigue, energy

• SHBG = sex hormone binding globulin • tightly BINDS Testosterone making it unavailable

• Total T = free T (unbound T) + bound T• ~6-28 nmol/L;

• AGE adjusted norms?: 40-59y =12.1-30; >60=6.9-25

• Bioavailable T = free T + T bound weakly

to albumin

• Free Androgen Index• 15-95 U

Testosterone (T) Levels

Males

Trials

• Limited - too small, too short– lack good data for large scale treatment of PADAM– some efficacy on some parameters– subjective benefits– safety data lacking

Benefit vs Risk

• body• strength• mood• libido• cognition• function

• prostate• cardiovascular• Hct (stroke)• gynecomastia

• treated with tamoxifen?

• inappropriate behavior• cost of treatment

Monitoring

• Symptoms/side effects

• Prostate– DRE, PSA *baseline, annual

• Lab– Hct, Hgb (stroke); lipids (heart)– testosterone

• Other

Androgens - Oral

• ANDRIOL– testosterone

undecanoate

– storage • refrigerate in pharmacy

• at room temperature after dispensing (Exp. 90 days)

– take after food

Androgens - Topical Gel

• ANDROGEL– testosterone 1% gel

– apply daily in AM

– a shirt prevents sharing

Androgens - Transdermal Patch

• ANDRODERM– testosterone

– apply daily at HS

– rotate sites weekly

– skin irritation common

Androgens - Injectable

• DELATESTRYL– Testosterone

enanthate• small volume

advantage

• DEPO-TESTOSTERONE– Testosterone

cypionate

Lower drug cost