Jozef Marenčák
The elderly population is the fastest growing age group and needs a considerable attention. Androgen decline represents
one of the most important medical aspect of elderly. Testosterone Deficiency Syndrome (TDS) is a clinical and biochemical
syndrome which results in significant detriment in the quality of life and adversely affects the function of multiple
organ systems. The pathophysiology of testosterone (T) decline in elderly is not yet completely defined. Potential
mechanisms include reduced hypothalamic GnRH outflow, impaired testicular steroidogenesis and altered sex – steroid
negative feedback. Androgen pharmaceutical worldwide marketplace has largely changed during last years by introduction
of new oral, parenteral and transdermal preparations. T supplementation is safe and efficacious in improving
symptoms associated with androgen deficiency. Risks of androgen replacement therapy (ART) are mild and contraindications
for T treatment well defined. A close monitoring during T administration is needed and timing and modalities
are very well indicated. One of the most controversial aspects of the ART remains the effect of T on prostate functioning.
To date, prospective studies have demonstrated a low frequency of prostate cancer in association with T replacement
therapy (TRP). Current standard of practice established categorically that the administration of androgen is absolutely
contraindicated in men suspected of or harbouring prostate and breast cancer. This includes those with an abnormal
digital rectal examination (DRE) and/ or abnormal prostate specific antigen (PSA), in whom the diagnosis of carcinoma
has not been excluded beyond doubt. There is not now – nor has there ever been – a scientific proof for the belief that
T causes prostate cancer to grow. Larger – scale and longer – term data are needed on the effects of T treatment in the
older population to confirm safety on specific risk data on the prostate and cardiovascular systems.