Androgen Deficiency in the Ageing Male 293 ANDROGEN DEFICIENCY IN THE AGEING MALE: POTENTIAL CLINICAL IMPORTANCE AND THERAPEUTIC CONSIDERATIONS

Expectation of life is increasing all over the world [1]. A considerable shift in the demographic structure of the popu­ lation in Central Europe is forecast for the next 30 years. By the year 2015 every fourth man and by the year 2030 every third man will have reached or exceeded the age of 60. This develop­ ment will have a serious impact on the health system. More and more men will suffer from the typical diseases of old age. From the perspective of urol­ ogy/andrology, lower urinary tract symptoms (LUTS), cancer of the pros­ tate and sexual dysfunctions will be to the fore. Whether men actually do have a climacterium and – like in women – treatment with sexual hormones is indi­ cated has been the subject of contro­ versial debate for many decades. As early as 1939, Werner drew attention to the potential associations between hot flushes, sleep disorders, depressive moods, lack of drive and high urine gonadotropin levels in older men [2, 3]. Several studies confirmed that the androgen levels decrease constantly in old age [4–6], but that only about 20–30% of all men develop a partial testosterone deficiency. Therefore, the terms “andropause” or “climacterium virile” are not really appropriate [7]. They have been replaced by the ex­ pression “partial androgen deficiency of the ageing man” (PADAM). Today, PADAM is the subject of intensive re­ search aimed at identifying the possible negative effects on the endocrine target organs, and finding a rational basis of hormone replacement therapy.