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 ???

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 = ; >60= Bioavailable T = free T + T bound weakly to albumin Free Androgen Index 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