Despite intensive research on testosterone therapy for older men, important questions remain unanswered. The evidence clearly indicates many older men display a partial androgen deficiency. In older men, low circulating testosterone is correlated with low muscle strength, with high adiposity, with insulin resistance and with poor cognitive performance.
Testosterone replacement in older men has produced benefits, but not consistently so. The inconsistency may arise from differences in the dose and duration of testosterone treatment, as well as selection of the target population.
Generally, studies reporting anabolic responses to testosterone Mature oldermen seniors employed higher doses of testosterone for longer treatment periods and have targeted older men whose baseline circulating bioavailable testosterone levels were low. Most studies of Mature oldermen seniors replacement have reported anabolic that are modest compared to what can be achieved with resistance exercise training. However, several strategies Mature oldermen seniors under evaluation have the potential to produce greater anabolic effects and to do so in a safe manner.
At this time, testosterone therapy can not be recommended for the general population of older Older men who are hypogonadal are at greater risk for the catabolic effects associated with a number of acute and chronic medical conditions.
Future research is likely to reveal benefits of testosterone therapy for some of these special populations. Testosterone therapy produces a number of adverse effects, including worsening of sleep apnea, gynecomastia, polycythemia and elevation of PSA. Efficacy and adverse effects should be assessed frequently throughout the course of therapy. In young adult men, the hypothalamic-pituitary-gonadal axis regulates the circulating concentration of testosterone.
The hypothalamic pulse generator secretes a pulse of gonadotropin releasing hormone GnRH approximately every 90 minutes Reyes-Fuentes and Veldhuis GnRH is secreted into the hypothalamic-pituitary portal circulation where it stimulates pituitary secretion of luteinizing hormone LH Veldhuis et al into the systemic circulation. LH reaches the testes and promotes both tonic and episodic Leydig cell secretion of testosterone. Nearly all of the testosterone circulating in the blood is bound to sex hormone-binding globulin SHBG or albumin.
The affinity of SHBG for testosterone is about 1,fold higher than the affinity of albumin for testosterone Pardridge et al Bioavailable testosterone in acts upon multiple target tissues and completes the feedback loop inhibiting GnRH and LH secretion.
The serum testosterone concentration displays both circadian and ultradian rhythms. The circadian rhythm results in peak testosterone serum concentrations during the early morning hours. In contrast, the ultradian rhythm has a cycle whereby the serum testosterone concentration fluctuates approximately every 90 minutes.
Unlike female menopause, the decline in testosterone serum concentration in men is gradual, and there is much inter-individual variability. Serum testosterone concentrations decline steadily after young adulthood, and by age of 80 years, the testosterone secretion rate decreases to approximately half that of a younger man Tenover et al ; Mulligan et al The decrease in bioavailable-testosterone appears to be greater than the decline in total testosterone with advancing age, due to an age-related increase in SHBG Rubens et al The decline in testosterone with aging has been referred to by a variety of names including male menopause, climacteric, viropause, andropause, ADAM androgen deficiency in aging menor age-associated hypogonadism.
Longitudinal studies confirm a decline in testosterone with aging, as has been reported earlier in cross-sectional studies Morley et al ; Feldman et al With age, changes that contribute to hypogonadism occur Mature oldermen seniors both the hypothalamus and testes.
The rise in LH following a decrease in testosterone is considerably "Mature oldermen seniors" with age Korenman et al ; Veldhuis et al This is likely due to failure of the hypothalamus to generate an appropriate burst of GnRH secretion Veldhuis al ; Mulligan et al The specific mechanism may be an age-related increased sensitivity of the hypothalamic-pituitary unit to the negative feedback effect of testosterone Winters et al In older men, the decline in circulating testosterone also correlates with changes in the testes, specifically a decline in Leydig cell number Neaves et aldevelopment of vacuolizations and lipofuscin within the Leydig cells, and decreased Leydig cell secretion of testosterone in response to provocative stimulation with human chorionic gonadotrophin Harman and Tsitouras The decline in bioavailable testosterone may be at least partially responsible for the decreased muscle mass, osteoporosis, mood disturbances, and frailty seen in older men Nunez The criteria for low testosterone are the same regardless of age.
The prevalence of hypogonadism increases with advancing age; the odds ratio of
Mature oldermen seniors is greater Mature oldermen seniors each year increase in age. Longitudinal studies in specific geographic areas of the United States and some small cross-sectional studies have demonstrated a decline in testosterone occurring as early as age 30, but usually testosterone levels remain within normal limits until men reach age 60 Belanger et al ; Morley et al Low serum testosterone concentration in older men is associated with depression Shores et al However, most trials of testosterone replacement have not shown improvement in depression.
Two small studies in Mature oldermen seniors hypogonadal men did show short term improvement in depression with testosterone supplementation, but this effect has not been reproduced in older men Pope et al The age of onset of depression may also be a factor in response to "Mature oldermen seniors." Perry et al reported that 6 weeks of testosterone treatment improved depression scores in men who had onset of depression after the age of 45 years, but not in men whose depression started at a younger age.
Higher bioavailable testosterone levels are associated with better performance in cognitive tests Barett-Connor et al Short-term trials in healthy eugonadal older men have shown improvement in verbal and spatial memory Cherrier et al ; Gray et al However, longer trials have produced mixed results.
Mature oldermen seniors et al reported no improvement in cognition or memory. Interestingly, improvements in verbal and spatial memory were observed only with the intermediate dose. Testosterone produces substantial anabolic effects in young and middle-aged hypogonadal men Bhasin et al In contrast, the anabolic effects of testosterone replacement therapy in older men have been harder to demonstrate. Among the many published trials of testosterone in older men, some report strength gains and some do not.
Only a few report strength gains that can be considered substantial in comparison to the benefits of Mature oldermen seniors exercise training. In cases, the studies reporting significant strength gains were performed in hypogonadal subjects and employed a higher dose of testosterone, for a longer duration.
Studies by Brill et alClague et alKenny et aland Snyder et al also report small increases in strength. Several investigators have reported that testosterone caused moderate increases in strength; increases that are significant, but are still below than what can be obtained through resistance exercise training.
Some subjects also received a weekly i. The addition of testosterone produced a trend toward greater increases overall, but the effect of testosterone appears to be substantial in the low-intensity training group. Considering that few men in the community will perform high-intensity training on their own, these results may indicate usefulness for testosterone therapy. Three studies have reported substantial strength gains following testosterone treatment and all have employed doses of testosterone that are somewhat higher than replacement doses.
Significant strength increases were observed, including a 15 kg increase in leg extension 1-RM strength. Page et al treated a group of older, hypogonadal men for 36 months with biweekly i.
However, the study that best demonstrates the dose dependence is that of Bhasin et al The dose of testosterone also appears to be critical in determining whether increases in bone mineral density are observed.
Mature oldermen seniors, Amory et al treated older hypogonadal men for 36 months with biweekly i. The lower rate of heart disease in women has historically been attributed to the cardioprotective effects of estrogen.
Presently, this position is being reexamined. The cardioprotective effects of estrogen have come into Mature oldermen seniors question and there is emerging evidence that testosterone may have cardioprotective effects of its own. Swartz and Young have shown that older men with a low circulating testosterone, a higher fraction have previously suffered a myocardial infarction. Testosterone supplementation in hypogonadal men improves exercise tolerance and decreases exercise-associated ischemia in elderly patients with coronary artery disease and low Malkin et al or low-normal English et al testosterone.
The vasodilatory effect has been confirmed in animal models English et al The beneficial effects are seen with both acute Rosano et al and chronic English et altestosterone administration, and also with low Malkin et al and high Rosano et al dose supplementation. However, none of these studies was long enough to show an effect on cardiovascular mortality. Although there has been concern that testosterone therapy might adversely affect serum cholesterol and lipids, this concern has not been bourn in controlled studies.
Wang et al reported that treating hypogonadal men with testosterone gel equivalent of 5—10 mg per day for 6 months did not produce significant changes in LDL- or HDL-cholesterol.
Whitsel et al performed a meta analysis of 19 studies involving administration of testosterone esters to older hypogonadal men and found that, on the whole, testosterone produces small, and probably offsetting, decreases in both HDL and LDL.
An additional cardiac benefit of testosterone may be seen in the findings of Malkin et alwho found that testosterone reduced circulating levels of tumor necrosis factor alpha and interleukin-1 beta, inflammatory cytokines that are elevated in heart failure.
Risks associated with testosterone replacement in elderly men include fluid retention, gynecomastia, worsening of sleep apnea, polycythemia and acceleration of benign or malignant prostatic disease Matsumoto Among these risks, the potential effects of testosterone on the prostate are of the greatest concern.
These concerns stem from the known action of testosterone in accelerating active prostate cancer and from the high prevalence of early-stage prostate cancer in elderly men. Clinical trials to date are not large enough or long enough to determine the potential effects of testosterone treatment on prostate cancer. Although Zitzmann et al have shown that replacement and slightly higher doses of testosterone produce a predictable and moderate degree of prostate enlargement, existing data do not indicate that testosterone promotes prostate cancer.
Hajjar et al treated elderly men with a replacement dose of testosterone and found no increase in prostate cancer during a 2-year follow-up. Agarwal and Oefelein administered testosterone for 19 months to hypogonadal patients with a history of prostate cancer and prostatectomy, but whose recent PSA levels were low. Treatment significantly elevated circulating testosterone and improved quality of life without elevating PSA.
Patients should be evaluated one month after initiation of treatment and the dose should be increased if symptoms of hypogonadism have Mature oldermen seniors improved.
Rhoden and Morgentaler have reviewed the adverse effects Mature oldermen seniors recommend the following monitoring. Safety monitoring should include sleep apnea, voiding symptoms, serum testosterone, PSA and hemoglobin or hematocrit and should be performed several times during the first year and yearly thereafter.
In response to concerns over the efficacy and risks of hormonal replacement in the elderly, the NIH commissioned an assessment by Institute of Medicine IOM.
The IOM report states that there is insufficient evidence to conclude that testosterone treatment in older men "Mature oldermen seniors" well established benefits. In addition, the IOM recommended that small and medium-sized trials be conducted to assess the efficacy of testosterone for treating muscle weakness, osteoporosis, sexual dysfunction, cognitive impairment and depression Liverman and Blazer The IOM does not recommend prevention trials or trials for all hypogonadal older men.
While we agree with these recommendations, at least two other avenues of exploration deserve attention. First, while replacement doses of testosterone do not consistently produce substantial increases in strength, Page et al and Bhasin et al have shown that higher doses of testosterone do produce such increases. Higher doses of testosterone also produce more adverse effects, especially prostate effects.
Strength, especially lower body strength, remains an important facto limiting the independence of older people. Currently, alternative strategies are being developed, aimed at stimulating the androgen receptor more powerfully, without producing added adverse effects.
One such strategy is to administer a higher dose of testosterone with
Mature oldermen seniors addition of a 5-alpha reductase inhibitor to prevent the prostate symptoms. Another strategy is the use of selective androgen receptor modulators SARMscurrently under development at several pharmaceutical firms.
A second avenue where more research is needed is testosterone therapy for special populations of men who are at risk for development of catabolic states and muscle wasting. Testosterone might be used to prevent disuse muscle atrophy following knee or hip replacement.
Gerontophilia is the primary sexual attraction to the elderly. A person with such a sexual preference is a gerontophile. The word gerontophilia was coined in.
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The senior population has steadily increased with each passing year. Community centers offer fun celebrations and outings in neighborhoods that assign many seniors to gather, unite one another and have group stimulation. Generally senior centers put forward a calendar of events and special celebrations during the holidays.
Senior community centers are an excellent way to meet others with similar interest in your community. For those wary of the World Wide Web and those too shy to happen on people in social settings — dating coaches, services and matchmakers are the way to go! Dating coaches and matchmakers seems to make sense and exhaust the barrier for many seniors.
But there are not as many men as women quietly because women typically outlive men. These services can be over the odds, though. While it can be more challenging to meet a possible mate on a incidental outing to the store, it makes for a romantic narrative for those who do appropriate on these happenstances!
Whether the stars are aligned for these couples, or luck plays a big role in their meeting; seniors have to be a bit more extroverted and pugnacious to meet in these settings. Believe it or not, uncountable find companionship and love in senior living communities. While seniors desire love and romance, they face obstacles beyond the popular norms and taboos.
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The International Osteoporosis Foundation IOF has released a new position statement on Vitamin D for older adults which makes important recommendations for vitamin D nutrition from an evidence-based perspective.
Osteoporos Int ;21 7: Vitamin D is important for bone and muscle development, function and preservation. For this reason it is a vital component in the maintenance of bone strength and in the prevention of falls and osteoporotic fractures. The best available clinical indicator of vitamin D status is serum 25OHD and vitamin D intake and effective sun exposure are the major determinants of this level.
Serum 25OHD levels decline with ageing but the response to vitamin D3 supplementation is not affected by age or by usual calcium dietary intake.
Preventing vitamin D deficiency has a major impact on falls and osteoporotic fractures.
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