Decreased testosterone

Both cross-sectional and longitudinal studies demonstrate a decline in serum testosterone concentration, an increase in sex hormone-binding globulin concentration (SHBG), and a decrease in free testosterone with age. It is important to note, however, that most commercially available assays for total and free testosterone (and calculated free testosterone formulae) have both theoretical and technical limitations that hinder a clinician's ability to reliably diagnose hypogonadism in an individual older man [ 1-3 ]. This issue is discussed in detail separately. (See "Clinical features and diagnosis of male hypogonadism", section on 'Serum total testosterone' .)

For both men and women, an alternative to testosterone replacement is low-dose clomifene treatment, which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects that can result from direct hormone replacement therapy. [17] This therapy has only been shown helpful for men with secondary hypogonadism. Recent studies have shown it can be safe and effective monotherapy for up to 2 years in patients with intact testicular function and impaired function of the HPTA( http:///ijir/journal/v15/n3/full/ ). Clomifene blocks estrogen from binding to some estrogen receptors in the hypothalamus, thereby causing an increased release gNRH and subsequently LH from the pituitary. Clomifene is a Selective Estrogen Reuptake Modulator (SERM). Generally clomifene does not have adverse effects at the doses used for this purpose. Clomifene at much higher doses is used to induce ovulation and has significant adverse effects in such a setting.

Decreased testosterone

decreased testosterone


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