Endocrine Abstracts

The burgeoning interest in treating androgen deficiency against the background of the age-related decline in circulating testosterone in middle-aged and elderly men has outpaced the accrual of an adequate evidence base on causation, natural history, and accuracy/validity of diagnosis. The relevance of age-related hormonal changes in the somatotrohic and adrenal axes are currently also unclear. Fuelled by the increased choice of androgen preparations and heightened patient expectation, clinicians are put under increasing pressure to prescribe without an assured diagnosis. A number of questionnaires have appeared that claim to improve the detection of symptomatic hypogonadism in elderly men – these have not been validated against clinical outcomes. Best practice interim recommendations have also recently been proffered from many quarters in attempts to rationalise management of ageing men suspected of being androgen deficient. The most important principles underpinning these guidelines include are the pre-requisites of clinical features supported by consistent biochemical evidence of testosterone deficiency and exclusion of recognisable reversible pathologies. How these principles can be applied in practice will be discussed. It must be emphasised that any current practice recommendations should be revised in the light of new and more substantial evidence from future research.