Testosterone deficiency syndrome - diagnosis and treatment - based on age-related testosterone referent levels

Abstract

Introduction. Androgen production decreases with men’s age, which is a result of the natural process of ageing. Total testosterone concentration decreases by average 1% a year. This process results in specific signs and symptoms, which are not only associated with the sexuality, but also negatively affect the bone mineral density and body content, increase the likelihood for metabolic syndrome, diabetes and cardiovascular disease. If low testosterone concentration is accompanied by hypogonadism clinical manifestations, the diagnosis is Testosterone Deficiency Syndrome (TDS). It is estimated that the syndrome affects 6-12% of men older than 45 years. The diagnosis is based on measuring testosterone concentration and assessing clinical manifestations. TDS is typically treated with testosterone replacement therapy. Leveling off testosterone deficiency results in better quality of life, sexual efficiency and beneficially affects many metabolic parameters. In practice, it influences the length and quality of life significantly. The present-day therapy is mainly based on testosterone esters used intramuscularly or 1% and 2% testosterone gel (topically). Another method, which has been known for over 50 years and is now enjoying its renaissance, is inducing testosterone endosynthesis by administering hCG. Yet, regardless of which therapy is applied, the most important is to establish standards for testosterone deficiency and standards for normal age-related testosterone levels, which will make the reference values in therapy. The present study is the first attempt worldwide to establish reference values for T concentrations in different age groups.
Material and methods. The basis for defining reference values of testosterone concentration in various age groups was a retrospective analysis of 1267 men examined, including 908 treated for TDS at the MAG Medical Center in Warsaw between 2000 and 2007. The therapeutic method was that of inducing T endosynthesis by administering hCG.
Results. The analysis of the patients treated revealed that TDS manifestations relieve at much higher T concentrations than what has been believed so far. T concentrations reached during the therapy resulted from physiological synthesis of testosterone in Leydig’s cells. These results were the basis for establishing reference T concentrations relevant for particular age groups.
Conclusions. The own material presented in the paper shows that the minimal values of testosterone treated as reference values so far at which testosterone treatment is recommended to be initiated, are definitely too low. Introducing T therapy only when the testosterone deficit has resulted in irreversible anatomical changes and lesions seems to be clearly delayed, and is harmful to men.
BPolish Sexology 2010; 8 (1): 1-16