Serum testosterone levels in South African men and the onset of androgen decline in ageing males.

Late-onset hypogonadism (LOH) in men is defined as ‘a clinical and biochemical syndrome, associated with advancing age and characterised by typical symptoms and a deficiency in serum testosterone levels’. Terms like ‘male climacterium’, ‘andropause’, or the ‘male menopause’ are misnomers of the condition, and their use is outdated. The testosterone deficiency may adversely affect the function of multiple organ systems and subsequently result in a significant loss of quality of life. Androgens are essential for the development and maintenance of male reproductive organs and male characteristics. Testosterone is the major androgen and only 1 2% of serum testosterone occurs in the free form. The rest is bound to sex hormone-binding globulin (SHBG) and albumin. Collectively, the free testosterone and albumin-bound fractions represent bio-available testosterone and more closely reflect the ‘true’ androgen status. In men, testosterone production is affected in a slowly progressive way after the age of 30 years, as part of the normal ageing process. In elderly men, the circadian rhythm of testosterone is lost and the early-morning peak is lowered. After 60 years, > 20% of men have subnormal testosterone levels and after 80 years, > 30% have subnormal levels. Between 25 and 75 years, the major decline occurs in the total serum testosterone (~30%); however, the decline in bio-available testosterone and free testosterone of ~50% is due to the age-associated increase in SHBG binding capacity. Acute or chronic illness, physical/psychological stress, surgery, substance abuse, etc. may accentuate the symptoms of age-associated testosterone decrease. The symptoms of LOH are nonspecific and usually develop in a slow progressive way over a relatively long period of time, making their appearance hardly perceptible. Mood changes are often the first to appear, but sexual and erectile symptoms are usually the complaints that will bring the patient to the physician. Body and visceral fat mass increase, inducing a higher risk of insulin resistance, type II diabetes mellitus, cardiovascular disease, osteoporosis, or even osteoporotic fractures may also be symptoms and signs. It is critical that no testosterone supplementation should be initiated without a proper and complete evaluation of the patient. This includes a detailed history and full clinical examination, a digital rectal examination (DRE) and serum prostate-specific antigen (PSA) test. The presence of prostate or breast cancer is an absolute contraindication to testosterone therapy. There seems to be no reason for denying a symptomatic, hypogonadal man testosterone therapy on the basis of a theoretical concern of prostate cancer. Studies on South African subjects