Circulating testosterone levels decline in ageing men, and low testosterone levels are associated with an increased risk of cardiovascular disease (CVD). There is controversy over the use of testosterone therapy and risk of adverse cardiovascular events in older men. Testosterone therapy should only be considered in men who are androgen deficient, and a cautious approach employed in older men with comorbidities including pre-existing CVD.
- Older men have lower testosterone concentrations compared with younger men, and lower circulating testosterone is a biomarker for poorer health outcomes.
- Whether testosterone supplementation in older men is associated with increased risk of cardiovascular events remains controversial, with contrasting reports and no evidence of excess events in a recent meta-analysis.
- The diagnosis of androgen deficiency should be made following careful clinical assessment and measurement of early morning testosterone concentrations using an accurate assay and age-appropriate reference intervals.
- Testosterone therapy in older men who are androgen deficient should aim for a testosterone concentration in the middle rather than the high end of the reference range.
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