Late-onset hypogonadism: an undertreated condition in aging Lebanese men.

“The day after the first subcutaneous injection, and still more after the two succeeding ones, a radical change took place in me... I had regained at least all the strength I possessed a good many years ago.” [1]. By these words, the 72 year-old physiologist Charles E. Brown-Sequard described in The Lancet the effects of self-administered extracts of dog and guinea pig testes. Even though BrownSequard acknowledged the possibility of a placebo effect, his widely publicized experiments led to derision by some, but also to an unscrupulous industry of testicular transplants in wealthy old men by others. Early man-to-man transplants gave way to chimpanzee testicular transplants in Europe when few human testicle donors came forward. In the United States, goat testicular transplants were marketed as a “cure” for aging males. Sixty years later, in 1939, Butenandt and Ruzicka shared the Nobel Prize in chemistry for synthesizing testosterone from cholesterol, independently of each other [2]. The term andropause, commonly used today by clinicians to denote the hypogonadal syndrome, first appeared in the literature in the 1940’s [3]. It refers to a cluster of symptoms and low testosterone levels in men over the age of 50 years. In 1944, Heller and Myers linked depression, fatigue, loss of libido and potency, and many other signs in aging males to lower than normal levels of testosterone, and found that symptoms improved when patients were administered replacement doses [3]. On Harley Street in London, synthetic testosterone replacement became a cure-all for many symptoms of aging. From these uncertain beginnings grew our understanding of the role of declining testosterone levels in the pathogenesis of certain age-related symptoms, and clinical research on hypogonadism and testosterone replacement has grown rapidly since. Was Brown-Sequard’s rejuvenating elixir the long sought-after hormonal fountain of youth? This review discusses the pathophysiology behind the age-associated decline in testosterone levels, as well as the promises, limitations, and risks of testosterone supplementation in hypogonadal males.