Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA; email:
Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo 05508-220, Brazil; email:
Annu Rev Med. 2021 Jan 27;72:75-91. doi: 10.1146/annurev-med-050219-034711. Epub 2020 Nov 20.
The substantial increase in life expectancy of men has focused growing attention on quality-of-life issues associated with reproductive aging. Serum total and free testosterone levels in men, after reaching a peak in the second and third decade of life, decline gradually with advancing age. The trajectory of age-related decline is affected by comorbid conditions, adiposity, medications, and genetic factors. Testosterone treatment of older men with low testosterone levels improves overall sexual activity, sexual desire, and erectile function; improves areal and volumetric bone density, as well as estimated bone strength in the spine and the hip; corrects unexplained anemia of aging; increases skeletal muscle mass, strength and power, self-reported mobility, and some measures of physical function; and modestly improves depressive symptoms. The long-term effects of testosterone on major cardiovascular events and prostate cancer risk remain unclear. The Endocrine Society recommends against testosterone therapy of all older men with low testosterone levels but suggests consideration of treatment on an individualized basis in men who have consistently low testosterone levels and symptoms or conditions suggestive of testosterone deficiency.
男性预期寿命的大幅延长，使人们越来越关注与生殖衰老相关的生活质量问题。男性的血清总睾酮和游离睾酮水平在生命的第二和第三个十年达到峰值后，随着年龄的增长逐渐下降。与年龄相关的下降轨迹受到合并症、肥胖、药物和遗传因素的影响。对于低睾酮水平的老年男性，睾酮治疗可改善整体性行为、性欲和勃起功能；改善脊柱和臀部的面积和体积骨密度以及估计的骨强度；纠正不明原因的老年贫血；增加骨骼肌质量、力量和功率、自我报告的活动能力以及某些身体功能的衡量指标；并适度改善抑郁症状。睾酮对主要心血管事件和前列腺癌风险的长期影响仍不清楚。内分泌学会不建议所有低睾酮水平的老年男性进行睾酮治疗，但建议对持续低睾酮水平且有睾酮缺乏症状或有提示症状的男性，根据个体情况考虑治疗。
