Investigation, treatment and monitoring of late-onset hypogonadism in males.

*Corresponding Author Androgen deficiency in the aging male has become a topic of increasing interest and debate throughout the world. The demographics clearly demonstrate the increasing percentage of the population that is in the older age groups. The data also support the concept that testosterone falls progressively with age and that a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young adults (age 20-30 years) men. The principal questions raised by these observations are whether older hypogonadal men will benefit from testosterone treatment and what will be the risks associated with such intervention. The past decade has brought evidence of benefit of androgen treatment on multiple target organs of hypogonadal men and recent studies show short-term beneficial effects of testosterone in older men that are similar to those in younger men. Long-term data on the effects of testosterone treatment in the older population are limited and specific risk data on the prostate and cardiovascular systems are needed. Answers to key questions of functional benefits that may retard frailty of the elderly are not yet available. The recommendations described below were prepared for the International Society of Andrology (ISA) and the International Society for the Study of the Aging Male (ISSAM) following a panel discussion with active participation from the audience sponsored by the ISA on the topic at the 4th ISSAM Congress in Prague in February 2004. The ISA Member Societies were requested to comment on the draft recommedations. Representatives of the European Association of Urology (EAU) participated in the final draft of this document. This document is not intended to provide evidence for each recommendation as review of pertinent studies have recently been comprehensively summarized in the Clinical Research Directions on “Testosterone and Aging” by the Institute of Medicine (Washington 2004). The recommendations will be subject to revision as larger-scale and longer-term data become available. In order to reach a large audience these recommendations are published in the International Journal of Andrology,the Journal of Andrology, The Aging Male and in European Urology. E Nieschlag * Institute of Reproductive Medicine University of Münster, Germany Email: eberhard.nieschlag@ukmuenster.de

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