American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Testosterone Deficiency: A Comprehensive Review


Testosterone Deficiency is a highly prevalent and under-diagnosed condition associated both with aging and common medical comorbidities, including metabolic syndrome and cardiovascular disease. Early evidence suggests that testosterone replacement therapy may reverse early diabetes and improve overall male health. A comprehensive review of testosterone deficiency was published in the July issue of The American Journal of Medicine.

Testosterone deficiency (TD) afflicts approximately 30% of men aged 40-79 years, with an increase in prevalence strongly associated with aging and common medical conditions including obesity, diabetes, and hypertension. A strong relationship is noted between TD and metabolic syndrome, although the relationship is not certain to be causal. Repletion of testosterone (T) in T-deficient men with these comorbidities may indeed reverse or delay their progression. While T repletion has been largely thought of in a sexual realm, we discuss its potential role in general men’s health concerns: metabolic, body composition, and all-cause mortality through the use of a single clinical vignette. This review examines a host of studies, with practical recommendations for diagnosis of TD and T repletion in middle-aged and older men, including an analysis of treatment modalities and areas of concerns and uncertainty.

Case Study Example
A 52-year-old man of Caucasian descent presented with erectile dysfunction (ED), diminished libido, and fatigue. He took no medications and was otherwise healthy. He was 5 feet, 7 inches tall (170 cm) and weighed 217 pounds (98 kg), with a body mass index of 34 kg/m2 and a waist circumference of 43 inches (109.2 cm). His blood pressure was 135/80 mm Hg. Laboratory values were all normal except for serum total testosterone of 270 ng/dL (9.37 nmol/L) (normal reference range 300-1000 ng/dL [10.4-34.7 nmol/L]) and fasting serum glucose of 110 mg/dL (6.1mmol/L) (normal 67-99 mg/dL [3.7-5.5mmol/L]), indicating a component of metabolic syndrome (MetS).1 What are the diagnostic, prognostic, and therapeutic issues in a man with symptomatic testosterone deficiency associated with the metabolic syndrome?

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— Abdulmaged M. Traish, MBA, PhD, Martin M. Miner, MD, Abraham Morgentaler, MD, Michael Zitzmann, MD

This article originally appeared in the July 2011 issue of The American Journal of Medicine.

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