Caveat Emptor: Does Testosterone Treatment Reduce Mortality in Men?

摘要

M implications of the age-related decline in circulat- ing testosterone (T) in aging men (1) and the decision to treat symptomatic men with androgen replacement (2, 3). There is a seductive simplicity to the conceptualization of low T in the elderly man as a straightforward problem of an age-related deficiency state— boosting the hormone level with treatment will remedy multiple problems of se- nescence whether they are sexual dysfunction, mobility limitation, diabetes, or cardiovascular disease. But the apparent relationships between T and various physio- logical deficits and adverse clinical outcomes are likely to be the result of complex interactions (bidirectional, nonlinear, and multilevel) between many coexisting fac- tors, some of which are known but others not. Low T may also be considered as a normal (adaptive) response to an abnormal environment (e.g. starvation, obesity) or pathological conditions (e.g. diabetes, cardiovascu- lar diseases, organ failure, or cancer) common in the elderly (4, 5). If this is the case, T treatment is not only unphysiological and inappropriate but may also poten- tially cause adverse effects (6).