Testicular Function

Ageing men undergo a gradual and moderate decrease in testicular function. This chapter summarises the available information on the diagnosis and management of patients with hypogonadism, with special focus on elderly men. Both cross-sectional and longitudinal studies demonstrate a gradual decline in serum T concentration starting after age 30. The rate of age-related decline in serum T concentrations varies in different individuals and is affected by chronic disease such as obesity, new illness, serious emotional stress, and medications. Normal spermatogenesis depends on the presence of intratesticular T. The diagnosis of hypogonadism requires the presence of symptoms and signs suggestive of T deficiency. Diagnostic workup should be conducted to establish the cause of hypogonadism. Several different types of T replacement exist, including oral capsules, injections, transdermal systems, pellets, and nasal preparations. T therapy consistently decreases subcutaneous fat mass but does not change visceral fat or hepatic fat content in elderly men.