The presence of prostate or breast carcinoma are absolute contra-indications for tes-tosterone treatment, but there are several additional adverse events that are particularly significant in the elderly. Although rarely seen, fluid retention in the chronically ill or the frailer older man may pose a problem. Modern testosterone preparations do not give rise to liver toxicity. Testosterone therapy has been reported to exacerbate sleep apnea; however, a recent 36-mo trial of testosterone in older men reported no effect on apneic or hypo-apneic episodes. Because of the relatively greater increase in serum E2 levels, gynecomastia is a rare event that can be overcome with a reduction in the testosterone dose.
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Benign prostatic hyperplasia and prostate cancer commonly occur in older men, and both are promoted by androgens and, therefore, have been treated by androgen depriva-tion therapy. It is unknown whether testosterone therapy for an older man places him at increased risk of developing clinically significant prostate disease from a pre-existing but subclinical condition. There have been at least 22 testosterone replacement trials, involving a total of 583 men ages 45 to 89, in which serum prostate-specific antigen (PSA) levels have been measured. Of the 22 studies, 16 showed no increase in PSA with tes-tosterone therapy.
In the six studies showing a PSA rise with testosterone, the average PSA change was 0.48 ng/mL, and the average PSA velocity was 0.52 ng/mL/yr. Seven testoster-one replacement trials in older men have evaluated prostate size, maximum urine flow rates, and/or International Prostate Symptom Scores. No change in any of these parameters was demonstrated with treatment erectile dysfunction – sildenafil Australia. These data suggest that in the short term (up to 3 yr), testosterone therapy in the older man has little effect on the prostate. Nevertheless, one must consider the longer term effects of testosterone therapy because prostate can-cer and benign prostatic hyperplasia are diseases with long natural histories, and the cur-rent observation time with testosterone therapy in older men is limited to less than 900 man-years. Testosterone therapy in older men can often result in a significant increase in red blood cell mass and hemoglobin levels. This may lead to either termination of therapy, a decrease of dose, or a switch to a different formulation of testosterone. The method of testosterone replacement may affect the magnitude of the change in red blood cell mass.