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The term Late Onset Hypogonadism (LOH), now preferred to Andropause of Male Menopause, is defined by the Society for the Study of the Ageing Male (ISSAM) as 'A clinical and biochemical syndrome associated with advancing age and characterised by typical symptoms and deficiency in serum testosterone levels'.

Safety First!
The decision to institute testosterone replacement in older men with low testosterone levels must be individualised and accompanied by a detailed discussion of the potential risks and benefits.

Question: Which older men should be given testosterone?
Answer: Those men who are significantly affected by having low levels of testosterone, who want it and who would benefit from its use. The risk of developing prostate cancer and other contra-indications to its use should be taken into account.

Meta-analysis of male HRT showed testosterone administration is associated with greater improvement in sexual function compared to placebo treatment in men with sexual dysfunction and low testosterone levels.

Testosterone may also favourably affect partner interactions and intimacy due to an overall increase in sexual desire and sense of well-being, independent of the change in erectile function

Specifically:
Testosterone restores erectile response in 40 - 60% of hypogonadal patients.

The 'best' treatment is currently testosterone plus a PDE5 inhibitor (e.g. Sildenafil, Vardenafil, Tadanafil) or Prostaglandin E1 (e.g. Caverject).

We may say that men are driven sexually by three forces: male hormones, that drive what we call 'libido': sexual desire, the motivation for which in any individual, is psychological and complex; and sexual self-image, the mental view men have of themselves as sexual beings which is psychologically, but also culturally, determined.

In my clinical experience older men often have loss of both libido and desire, while retaining a strong image of themselves as sexual beings. In the service of this self-image they often welcome the opportunity of medical intervention, as offered within the specialty of anti-aging medicine, to maintain or recover sexual function.

This we do by androgen replacement, following proper assessment and selection of patients, with the addition of chemical aids to erection if necessary.

This presentation will focus on the diagnosis, assessment and safe treatment of testosterone depletion in later life, called Late Onset Hypogonadism

The following are extracts from a presentation given by Dr Perring on the subject of Late Onset Hypogonadism at the Conference of the European Society of Antiageing Medicine held in Monaco March 2007:

Clinically, symptoms of LOH are:

• Reduced lean body mass, loss of muscle volume/strength
• Reduced erection strength (also nocturnal erections)
• Increased visceral fat
• Reduced bone mineral density (osteopenia/osteoporosis)
• Fatigue, depression and irritability
• Reduced cognitive functions and spatial orientation
• Reduced libido and fantasies
• Reduced body hair and skin tone/thickness
  (ISSAM 2002)

For the maintenance of satisfying sex consider the whole person:

Hormones and other aids to arousal are only part of a complex social/biological system

Consider also lifestyle factors (nutrition, exercise, 'stress') and the relationship of the couple (communication, intimacy and maturation towards autonomy)

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