AB022. Role of androgen on health longevity in aging society

Background: Recent basic and clinical works reveal various physiological functions of androgen. Androgen plays broader roles in men’s health through many biological actions in the central and peripheral organs systems. I would like to summarize critical roles of androgen [testosterone (T)] on male sexual function and health longevity in aging society based on our clinical findings and recent reports.

Methods: Clinical findings in late-onset hypogonadism (LOH) clinic. Clinical efficacy of testosterone replacement therapy (TRT) for various conditions associated with T deficiency (TD) has been reported. However, clinical diagnosis of LOH remains a controversial concept. Symptoms of LOH syndrome are non-specific and mimicked by other prevalent diseases such as depression. It is still a difficult task to diagnose LOH syndrome and select proper candidates for TRT. Self-referred patients who visited our LOH clinic were evaluated to clarify clinical features of them. Two obvious trends of chief complains of the patients were found. First point is that major chief complains of middle aged men were depressive symptoms, loss of energy. As second point, physiological complains such as hot flash and sweating were frequently found in elderly patients. The age associated decrease in T level may be partly responsible for these symptoms.

Results: Roles of androgens on Men’s health longevity in aging society. Depressive symptoms, loss of energy in middle aged-patients were frequently associated with other co-morbidities, such as depressive state, metabolic problems [obesity, diabetes, metabolic syndrome (Mets)] and erectile dysfunction. In diagnosis for LOH syndrome, we should pay attention to recognize for significant numbers of the patients who visited for LOH clinic are undiagnosed major depressive disorder. Clinical evidences support tight associations between TD and Mets, body compositions (fat and lean muscle mass) and bone metabolism. However, there was no patient who visited our LOH-clinic to refer for these metabolic issues as a chief complain. As treatment for depressive symptoms in middle aged men, TRT combined with or without PDE5-Is may alleviate mental conditions in these patients through improvement of their sexual function. Improvement of sexual function is able to be a chance to start own life-style modification. Hot flash and sweating in elderly men have not been considered as significant clinical problems except adverse symptoms under androgen deprivation therapy for prostate cancer. These symptoms impaired patients’ quality of life (QOL). TRT doesn’t always work well for hot flash and sweating. Establishment of management of these symptoms is required.

Conclusions: In aging society, the importance of lifelong education for roles of androgens and its replacement therapy further increases. In addition, to advance proper diagnosis and indication of TRT, more understandings on mechanism and metabolism of androgens in various organs and tissue are required.

Keywords: Late-onset hypogonadism; testosterone replacement therapy; quality of life