Male Hypogonadism in Advanced Age (Therapeutic Considerations), Gynecomastia in Advanced Age, Benign Prostatic Hypertrophy and Prostate Cancer (Endocrinological Aspects of Development and Treatment)

Treatment of male hypogonadism with testosterone (T) aims to replicate the physiological actions of endogenous T. Benefits are well demonstrated in men of any age with organic hypogonadism, who should be treated, except for those with absolute contraindications (prostate and breast cancer). Recommendations for T treatment follow the Endocrine Society Clinical Guidelines. Serum total T is recommended to be within the low-normal range (300-400 ng/dL). The different T preparations are reviewed. Preferred T formulations are those that maintain stable serum concentrations and mild clinical effects. Replacement T treatment increases prostate volume and PSA. No increased incidence of prostate cancer has been demonstrated in hypogonadal men on T therapy but monitoring of the prostate is mandatory. Recommended monitoring includes at least total T levels, serum PSA, rectal examination of the prostate, surveillance for apnea-hypopnea-sleep syndrome, and erythrocytosis. Most studies and meta-analyses described in this review have shown no increase in cardiovascular events. However published data are controversial. An increase in risk in men of middle and advanced age cannot be excluded until much larger and longer duration studies are completed. Gynecomastia is Identifiable in 1/3 of men in middle or advanced age. We describe the major etiopathogenic factors and diagnostic evaluation based on clinical manifestations and hormonal determinations as well as therapeutic management. Benign prostatic hypertrophy and prostate cancer are related to biological aging. The chapter will explore the pathogenesis and therapeutic considerations of each process. Special mention is made of the rationale and current drugs used for the hormonal treatment of prostate cancer.