Androgens in the impotent aging males

ABSTRACT

To clarify the biological significance of age-related decline in testosterone levels and to determine the possible risks and benefits of androgen therapy in the impotent aging males. This study included 54 male patients complaining of weak erection. After thorough history taking, physical examination, two questionnaires' evaluation for quality of life and Massachusetts Male Aging Sexual Activity, the patients were treated with intramuscular injection of testosterone enanthate 250mg/three weeks for six months. Laboratory investigations, including total and free testosterone, luteinizing hormone [LH], estradiol, prostate specific antigen [PSA], complete blood picture, liver function tests and lipid profile, were done before and after treatment. Another group of 54 healthy males with matched age group and without erectile problems were taken as a control for the hormonal status. Getting erection, keeping it and sexual satisfaction were significantly improved, although no significant change was noticed in the frequency of sexual activity, full hard erection or awaken with erection after testosterone therapy as measured by Massachusetts Male Aging Study [MMAS] sexual activity questionnaire. While sexual desire and night erections were slightly improved, no changes in orgasm, vaginal penetration, general and local genital examination were observed after testosterone therapy. Physical and cognitive problems were significantly improved after testosterone therapy while affective problems did not change as measured by quality of life questionnaire. Testosterone therapy had no significant effect on red blood cells count, haemoglobin concentration, haematocrite percentage, platelet counts, serum lipid profiles and serum hepatic functions. Although no significant changes were observed in testosterone [total and free], estradiol and PSA levels, there was a significant decline in LH level after testosterone therapy. No significant difference as regards the total and free testosterone levels between the patients included and the control group. In conclusion, knowledge of the potential benefits and risks of testosterone therapy has increased dramatically, but there is still much that needs to be determined. Beneficial effects of testosterone therapy on physical problems, cognitive problems, getting erection, keeping erection and sexual satisfaction can be found. To prove or disprove that testosterone therapy will increase the risk of developing or worsening cardiovascular or prostate disease, however, will require the establishment of well-controlled large multicentric studies