Symptomatic impact of testosterone therapy

Background: relative androgen deficiency in ageing males is assumed to have adverse health effects. This study assessed the effect of 12 months’ standard dose, oral testosterone, on symptoms attributed to testosterone deficiency in older men with plasma testosterone levels in the low–normal range for young men. Methods: testosterone undecanoate (TU, 80 mg bid) or placebo was administered for one year to 76 healthy men, 60 years or older, with a free testosterone index (FTI) of 0.3–0.5 and significant symptoms on a questionnaire designed to evaluate androgen deficiency (ADAM). The ADAM was completed at baseline, 6 and 12 months. Hormone and safety data were collected at baseline, 1, 3, 6 and 12 months. Results: after 12 months, plasma total testosterone was unchanged in both groups and sex hormone binding globulin decreased in the testosterone group (P= 0.01). FTI and calculated bioavailable testosterone (cBT) were greater in the testosterone group as compared with the placebo group (P= 0.021 and 0.025, respectively). There was no significant difference in total symptom score between testosterone and placebo groups after 12 months of oral TU. However, there were trends toward improvements in sadness/grumpiness (P= 0.063), reduced erection strength (P= 0.059) and decreased work performance symptoms (P= 0.077), particularly in men with baseline cBT levels below 3.1 nmol/l. Conclusions: this study concludes that 80 mg bid oral TU does not improve overall ADAM questionnaire scores in older men with low–normal gonadal status. Oral TU may preserve mood and erectile function, as assessed by this questionnaire, particularly in men with the lowest testosterone levels.