Search tips
Search criteria 


Logo of westjmedLink to Publisher's site
West J Med. 1993 November; 159(5): 579–585.
PMCID: PMC1022348

Androgen deficiency and aging in men.


Androgen levels decrease with age in men. Androgen deficiency in men older than 65 years leads to asthenia, a decrease in muscle mass, osteoporosis, and a decrease in sexual activity. Androgen deficiency has been reported to cause changes in mood and cognitive function. The combination of these factors results in impaired quality of life in older men. Androgen replacement therapy in hypogonadal men increases bone and muscle mass, enhances muscle and cardiovascular function, and improves sexual function and general well-being; whether elderly men experience benefits of androgen replacement is not known. These benefits have to be weighed against the possible adverse effects of prostate and cardiovascular diseases. Careful long-term studies are needed to assess the risk-to-reward ratios of androgen or other hormone replacement therapy before treatment strategies similar to estrogen therapy for postmenopausal women are implemented.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Vermeulen A, Rubens R, Verdonck L. Testosterone secretion and metabolism in male senescence. J Clin Endocrinol Metab. 1972 Apr;34(4):730–735. [PubMed]
  • Stearns EL, MacDonnell JA, Kaufman BJ, Padua R, Lucman TS, Winter JS, Faiman C. Declining testicular function with age. Hormonal and clinical correlates. Am J Med. 1974 Nov;57(5):761–766. [PubMed]
  • Rubens R, Dhont M, Vermeulen A. Further studies on Leydig cell function in old age. J Clin Endocrinol Metab. 1974 Jul;39(1):40–45. [PubMed]
  • Baker HW, Burger HG, de Kretser DM, Hudson B, O'Connor S, Wang C, Mirovics A, Court J, Dunlop M, Rennie GC. Changes in the pituitary-testicular system with age. Clin Endocrinol (Oxf) 1976 Jul;5(4):349–372. [PubMed]
  • Vermeulen A. Clinical review 24: Androgens in the aging male. J Clin Endocrinol Metab. 1991 Aug;73(2):221–224. [PubMed]
  • Gray A, Feldman HA, McKinlay JB, Longcope C. Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 1991 Nov;73(5):1016–1025. [PubMed]
  • Gray A, Berlin JA, McKinlay JB, Longcope C. An examination of research design effects on the association of testosterone and male aging: results of a meta-analysis. J Clin Epidemiol. 1991;44(7):671–684. [PubMed]
  • Bremner WJ, Vitiello MV, Prinz PN. Loss of circadian rhythmicity in blood testosterone levels with aging in normal men. J Clin Endocrinol Metab. 1983 Jun;56(6):1278–1281. [PubMed]
  • Harman SM, Tsitouras PD. Reproductive hormones in aging men. I. Measurement of sex steroids, basal luteinizing hormone, and Leydig cell response to human chorionic gonadotropin. J Clin Endocrinol Metab. 1980 Jul;51(1):35–40. [PubMed]
  • Sparrow D, Bosse R, Rowe JW. The influence of age, alcohol consumption, and body build on gonadal function in men. J Clin Endocrinol Metab. 1980 Sep;51(3):508–512. [PubMed]
  • Nieschlag E, Lammers U, Freischem CW, Langer K, Wickings EJ. Reproductive functions in young fathers and grandfathers. J Clin Endocrinol Metab. 1982 Oct;55(4):676–681. [PubMed]
  • Pirke KM, Doerr P. Age related changes in free plasma testosterone, dihydrotestosterone and oestradiol. Acta Endocrinol (Copenh) 1975 Sep;80(1):171–178. [PubMed]
  • Deslypere JP, Vermeulen A. Leydig cell function in normal men: effect of age, life-style, residence, diet, and activity. J Clin Endocrinol Metab. 1984 Nov;59(5):955–962. [PubMed]
  • Nankin HR, Calkins JH. Decreased bioavailable testosterone in aging normal and impotent men. J Clin Endocrinol Metab. 1986 Dec;63(6):1418–1420. [PubMed]
  • Korenman SG, Morley JE, Mooradian AD, Davis SS, Kaiser FE, Silver AJ, Viosca SP, Garza D. Secondary hypogonadism in older men: its relation to impotence. J Clin Endocrinol Metab. 1990 Oct;71(4):963–969. [PubMed]
  • Zumoff B, Strain GW, Kream J, O'Connor J, Rosenfeld RS, Levin J, Fukushima DK. Age variation of the 24-hour mean plasma concentrations of androgens, estrogens, and gonadotropins in normal adult men. J Clin Endocrinol Metab. 1982 Mar;54(3):534–538. [PubMed]
  • Johnson L. Spermatogenesis and aging in the human. J Androl. 1986 Nov-Dec;7(6):331–354. [PubMed]
  • Harman SM, Tsitouras PD, Costa PT, Blackman MR. Reproductive hormones in aging men. II. Basal pituitary gonadotropins and gonadotropin responses to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab. 1982 Mar;54(3):547–551. [PubMed]
  • Winters SJ, Troen P. Episodic luteinizing hormone (LH) secretion and the response of LH and follicle-stimulating hormone to LH-releasing hormone in aged men: evidence for coexistent primary testicular insufficiency and an impairment in gonadotropin secretion. J Clin Endocrinol Metab. 1982 Sep;55(3):560–565. [PubMed]
  • Warner BA, Dufau ML, Santen RJ. Effects of aging and illness on the pituitary testicular axis in men: qualitative as well as quantitative changes in luteinizing hormone. J Clin Endocrinol Metab. 1985 Feb;60(2):263–268. [PubMed]
  • Tenover JS, Dahl KD, Hsueh AJ, Lim P, Matsumoto AM, Bremner WJ. Serum bioactive and immunoreactive follicle-stimulating hormone levels and the response to clomiphene in healthy young and elderly men. J Clin Endocrinol Metab. 1987 Jun;64(6):1103–1108. [PubMed]
  • Deslypere JP, Kaufman JM, Vermeulen T, Vogelaers D, Vandalem JL, Vermeulen A. Influence of age on pulsatile luteinizing hormone release and responsiveness of the gonadotrophs to sex hormone feedback in men. J Clin Endocrinol Metab. 1987 Jan;64(1):68–73. [PubMed]
  • Tsitouras PD. Effects of age on testicular function. Endocrinol Metab Clin North Am. 1987 Dec;16(4):1045–1059. [PubMed]
  • Mineau GP, Trussell J. A specification of marital fertility by parents' age, age at marriage and marital duration. Demography. 1982 Aug;19(3):335–350. [PubMed]
  • Davidson JM, Chen JJ, Crapo L, Gray GD, Greenleaf WJ, Catania JA. Hormonal changes and sexual function in aging men. J Clin Endocrinol Metab. 1983 Jul;57(1):71–77. [PubMed]
  • Davidson JM, Camargo CA, Smith ER. Effects of androgen on sexual behavior in hypogonadal men. J Clin Endocrinol Metab. 1979 Jun;48(6):955–958. [PubMed]
  • O'Carroll R, Bancroft J. Testosterone therapy for low sexual interest and erectile dysfunction in men: a controlled study. Br J Psychiatry. 1984 Aug;145:146–151. [PubMed]
  • Christiansen K, Knussmann R. Sex hormones and cognitive functioning in men. Neuropsychobiology. 1987;18(1):27–36. [PubMed]
  • Sherwin BB, Gelfand MM. The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med. 1987 Jul-Aug;49(4):397–409. [PubMed]
  • Farmer ME, White LR, Brody JA, Bailey KR. Race and sex differences in hip fracture incidence. Am J Public Health. 1984 Dec;74(12):1374–1380. [PubMed]
  • Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ., 3rd Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporosis. J Clin Invest. 1981 Feb;67(2):328–335. [PMC free article] [PubMed]
  • Meier DE, Orwoll ES, Jones JM. Marked disparity between trabecular and cortical bone loss with age in healthy men. Measurement by vertebral computed tomography and radial photon absorptiometry. Ann Intern Med. 1984 Nov;101(5):605–612. [PubMed]
  • Orwoll ES, Oviatt SK, McClung MR, Deftos LJ, Sexton G. The rate of bone mineral loss in normal men and the effects of calcium and cholecalciferol supplementation. Ann Intern Med. 1990 Jan 1;112(1):29–34. [PubMed]
  • Orwoll ES, Oviatt SK, Mann T. The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab. 1990 Apr;70(4):1202–1207. [PubMed]
  • Santavirta S, Konttinen YT, Heliövaara M, Knekt P, Lüthje P, Aromaa A. Determinants of osteoporotic thoracic vertebral fracture. Screening of 57,000 Finnish women and men. Acta Orthop Scand. 1992 Apr;63(2):198–202. [PubMed]
  • Colvard DS, Eriksen EF, Keeting PE, Wilson EM, Lubahn DB, French FS, Riggs BL, Spelsberg TC. Identification of androgen receptors in normal human osteoblast-like cells. Proc Natl Acad Sci U S A. 1989 Feb;86(3):854–857. [PubMed]
  • Kasperk CH, Wergedal JE, Farley JR, Linkhart TA, Turner RT, Baylink DJ. Androgens directly stimulate proliferation of bone cells in vitro. Endocrinology. 1989 Mar;124(3):1576–1578. [PubMed]
  • Fukayama S, Tashjian AH., Jr Direct modulation by androgens of the response of human bone cells (SaOS-2) to human parathyroid hormone (PTH) and PTH-related protein. Endocrinology. 1989 Oct;125(4):1789–1794. [PubMed]
  • Seeman E, Melton LJ, 3rd, O'Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med. 1983 Dec;75(6):977–983. [PubMed]
  • Francis RM, Peacock M, Aaron JE, Selby PL, Taylor GA, Thompson J, Marshall DH, Horsman A. Osteoporosis in hypogonadal men: role of decreased plasma 1,25-dihydroxyvitamin D, calcium malabsorption, and low bone formation. Bone. 1986;7(4):261–268. [PubMed]
  • Greenspan SL, Neer RM, Ridgway EC, Klibanski A. Osteoporosis in men with hyperprolactinemic hypogonadism. Ann Intern Med. 1986 Jun;104(6):777–782. [PubMed]
  • Jackson JA, Kleerekoper M, Parfitt AM, Rao DS, Villanueva AR, Frame B. Bone histomorphometry in hypogonadal and eugonadal men with spinal osteoporosis. J Clin Endocrinol Metab. 1987 Jul;65(1):53–58. [PubMed]
  • Finkelstein JS, Klibanski A, Neer RM, Greenspan SL, Rosenthal DI, Crowley WF., Jr Osteoporosis in men with idiopathic hypogonadotropic hypogonadism. Ann Intern Med. 1987 Mar;106(3):354–361. [PubMed]
  • Stepán JJ, Lachman M, Zverina J, Pacovský V, Baylink DJ. Castrated men exhibit bone loss: effect of calcitonin treatment on biochemical indices of bone remodeling. J Clin Endocrinol Metab. 1989 Sep;69(3):523–527. [PubMed]
  • Finkelstein JS, Klibanski A, Neer RM, Doppelt SH, Rosenthal DI, Segre GV, Crowley WF., Jr Increases in bone density during treatment of men with idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 1989 Oct;69(4):776–783. [PubMed]
  • Diamond T, Stiel D, Posen S. Effects of testosterone and venesection on spinal and peripheral bone mineral in six hypogonadal men with hemochromatosis. J Bone Miner Res. 1991 Jan;6(1):39–43. [PubMed]
  • Baillie SP, Davison CE, Johnson FJ, Francis RM. Pathogenesis of vertebral crush fractures in men. Age Ageing. 1992 Mar;21(2):139–141. [PubMed]
  • Foresta C, Ruzza G, Mioni R, Guarneri G, Gribaldo R, Meneghello A, Mastrogiacomo I. Osteoporosis and decline of gonadal function in the elderly male. Horm Res. 1984;19(1):18–22. [PubMed]
  • Kelly PJ, Pocock NA, Sambrook PN, Eisman JA. Dietary calcium, sex hormones, and bone mineral density in men. BMJ. 1990 May 26;300(6736):1361–1364. [PMC free article] [PubMed]
  • Stanley HL, Schmitt BP, Poses RM, Deiss WP. Does hypogonadism contribute to the occurrence of a minimal trauma hip fracture in elderly men? J Am Geriatr Soc. 1991 Aug;39(8):766–771. [PubMed]
  • Tenover JS. Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab. 1992 Oct;75(4):1092–1098. [PubMed]
  • Flynn MA, Nolph GB, Baker AS, Martin WM, Krause G. Total body potassium in aging humans: a longitudinal study. Am J Clin Nutr. 1989 Oct;50(4):713–717. [PubMed]
  • Mooradian AD, Morley JE, Korenman SG. Biological actions of androgens. Endocr Rev. 1987 Feb;8(1):1–28. [PubMed]
  • Wilson JD. Androgen abuse by athletes. Endocr Rev. 1988 May;9(2):181–199. [PubMed]
  • Griggs RC, Kingston W, Jozefowicz RF, Herr BE, Forbes G, Halliday D. Effect of testosterone on muscle mass and muscle protein synthesis. J Appl Physiol (1985) 1989 Jan;66(1):498–503. [PubMed]
  • Welle S, Jozefowicz R, Forbes G, Griggs RC. Effect of testosterone on metabolic rate and body composition in normal men and men with muscular dystrophy. J Clin Endocrinol Metab. 1992 Feb;74(2):332–335. [PubMed]
  • Reed RL, Pearlmutter L, Yochum K, Meredith KE, Mooradian AD. The relationship between muscle mass and muscle strength in the elderly. J Am Geriatr Soc. 1991 Jun;39(6):555–561. [PubMed]
  • Sinaki M. Exercise and osteoporosis. Arch Phys Med Rehabil. 1989 Mar;70(3):220–229. [PubMed]
  • Snow-Harter C, Bouxsein M, Lewis B, Charette S, Weinstein P, Marcus R. Muscle strength as a predictor of bone mineral density in young women. J Bone Miner Res. 1990 Jun;5(6):589–595. [PubMed]
  • Bevier WC, Wiswell RA, Pyka G, Kozak KC, Newhall KM, Marcus R. Relationship of body composition, muscle strength, and aerobic capacity to bone mineral density in older men and women. J Bone Miner Res. 1989 Jun;4(3):421–432. [PubMed]
  • Prince RL, Smith M, Dick IM, Price RI, Webb PG, Henderson NK, Harris MM. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med. 1991 Oct 24;325(17):1189–1195. [PubMed]
  • Craig BW, Brown R, Everhart J. Effects of progressive resistance training on growth hormone and testosterone levels in young and elderly subjects. Mech Ageing Dev. 1989 Aug;49(2):159–169. [PubMed]
  • Sakamoto K, Wakabayashi I, Yoshimoto S, Masui H, Katsuno S. Effects of physical exercise and cold stimulation on serum testosterone level in men. Nihon Eiseigaku Zasshi. 1991 Jun;46(2):635–638. [PubMed]
  • Kraemer WJ, Gordon SE, Fleck SJ, Marchitelli LJ, Mello R, Dziados JE, Friedl K, Harman E, Maresh C, Fry AC. Endogenous anabolic hormonal and growth factor responses to heavy resistance exercise in males and females. Int J Sports Med. 1991 Apr;12(2):228–235. [PubMed]
  • Pyka G, Wiswell RA, Marcus R. Age-dependent effect of resistance exercise on growth hormone secretion in people. J Clin Endocrinol Metab. 1992 Aug;75(2):404–407. [PubMed]
  • Belman MJ, Gaesser GA. Exercise training below and above the lactate threshold in the elderly. Med Sci Sports Exerc. 1991 May;23(5):562–568. [PubMed]
  • Rudman D, Kutner MH, Rogers CM, Lubin MF, Fleming GA, Bain RP. Impaired growth hormone secretion in the adult population: relation to age and adiposity. J Clin Invest. 1981 May;67(5):1361–1369. [PMC free article] [PubMed]
  • Pavlov EP, Harman SM, Merriam GR, Gelato MC, Blackman MR. Responses of growth hormone (GH) and somatomedin-C to GH-releasing hormone in healthy aging men. J Clin Endocrinol Metab. 1986 Mar;62(3):595–600. [PubMed]
  • Vermeulen A. Nyctohemeral growth hormone profiles in young and aged men: correlation with somatomedin-C levels. J Clin Endocrinol Metab. 1987 May;64(5):884–888. [PubMed]
  • Florini JR, Prinz PN, Vitiello MV, Hintz RL. Somatomedin-C levels in healthy young and old men: relationship to peak and 24-hour integrated levels of growth hormone. J Gerontol. 1985 Jan;40(1):2–7. [PubMed]
  • Rudman D. Growth hormone, body composition, and aging. J Am Geriatr Soc. 1985 Nov;33(11):800–807. [PubMed]
  • Copeland KC, Colletti RB, Devlin JT, McAuliffe TL. The relationship between insulin-like growth factor-I, adiposity, and aging. Metabolism. 1990 Jun;39(6):584–587. [PubMed]
  • Poehlman ET, Copeland KC. Influence of physical activity on insulin-like growth factor-I in healthy younger and older men. J Clin Endocrinol Metab. 1990 Dec;71(6):1468–1473. [PubMed]
  • Rudman D, Feller AG, Nagraj HS, Gergans GA, Lalitha PY, Goldberg AF, Schlenker RA, Cohn L, Rudman IW, Mattson DE. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990 Jul 5;323(1):1–6. [PubMed]
  • Lamberts SW, Valk NK, Binnerts A. The use of growth hormone in adults: a changing scene. Clin Endocrinol (Oxf) 1992 Aug;37(2):111–115. [PubMed]
  • Liu L, Merriam GR, Sherins RJ. Chronic sex steroid exposure increases mean plasma growth hormone concentration and pulse amplitude in men with isolated hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 1987 Apr;64(4):651–656. [PubMed]
  • Ulloa-Aguirre A, Blizzard RM, Garcia-Rubi E, Rogol AD, Link K, Christie CM, Johnson ML, Veldhuis JD. Testosterone and oxandrolone, a nonaromatizable androgen, specifically amplify the mass and rate of growth hormone (GH) secreted per burst without altering GH secretory burst duration or frequency or the GH half-life. J Clin Endocrinol Metab. 1990 Oct;71(4):846–854. [PubMed]
  • Bardin CW, Swerdloff RS, Santen RJ. Androgens: risks and benefits. J Clin Endocrinol Metab. 1991 Jul;73(1):4–7. [PubMed]
  • McConnell JD. Androgen ablation and blockade in the treatment of benign prostatic hyperplasia. Urol Clin North Am. 1990 Aug;17(3):661–670. [PubMed]
  • Barrett-Connor E. Lower endogenous androgen levels and dyslipidemia in men with non-insulin-dependent diabetes mellitus. Ann Intern Med. 1992 Nov 15;117(10):807–811. [PubMed]
  • Friedl KE, Hannan CJ, Jr, Jones RE, Plymate SR. High-density lipoprotein cholesterol is not decreased if an aromatizable androgen is administered. Metabolism. 1990 Jan;39(1):69–74. [PubMed]
  • Thompson PD, Cullinane EM, Sady SP, Chenevert C, Saritelli AL, Sady MA, Herbert PN. Contrasting effects of testosterone and stanozolol on serum lipoprotein levels. JAMA. 1989 Feb 24;261(8):1165–1168. [PubMed]
  • Bhasin S, Swerdloff RS, Steiner B, Peterson MA, Meridores T, Galmirini M, Pandian MR, Goldberg R, Berman N. A biodegradable testosterone microcapsule formulation provides uniform eugonadal levels of testosterone for 10-11 weeks in hypogonadal men. J Clin Endocrinol Metab. 1992 Jan;74(1):75–83. [PubMed]
  • Friedl KE, Jones RE, Hannan CJ, Jr, Plymate SR. The administration of pharmacological doses of testosterone or 19-nortestosterone to normal men is not associated with increased insulin secretion or impaired glucose tolerance. J Clin Endocrinol Metab. 1989 May;68(5):971–975. [PubMed]
  • Matsumoto AM, Sandblom RE, Schoene RB, Lee KA, Giblin EC, Pierson DJ, Bremner WJ. Testosterone replacement in hypogonadal men: effects on obstructive sleep apnoea, respiratory drives, and sleep. Clin Endocrinol (Oxf) 1985 Jun;22(6):713–721. [PubMed]
  • Ammus SS. The role of androgens in the treatment of hematologic disorders. Adv Intern Med. 1989;34:191–208. [PubMed]
  • Palacios A, Campfield LA, McClure RD, Steiner B, Swerdloff RS. Effect of testosterone enanthate on hematopoiesis in normal men. Fertil Steril. 1983 Jul;40(1):100–104. [PubMed]
  • Krauss DJ, Taub HA, Lantinga LJ, Dunsky MH, Kelly CM. Risks of blood volume changes in hypogonadal men treated with testosterone enanthate for erectile impotence. J Urol. 1991 Dec;146(6):1566–1570. [PubMed]

Articles from The Western Journal of Medicine are provided here courtesy of BMJ Publishing Group