Testosterone Replacement Therapy in the Aged Male: Monitoring Patients’ Quality of Life Utilizing Scoring Systems

Abstract

Hypogonadism has been associated with significant deterioration of well-being. In the aging male, late-onset hypogonadism affects sexual life, mental health, levels of energy, lower urinary tract symptoms and, therefore, quality of life may be found significantly deteriorated. Testosterone replacement or supplementation therapy has been found efficient to reverse the adverse effects of hypogonadism and improve quality of life. Scales and questionnaires assessing the general health, urinary symptoms, sexual health, and cognition can provide a thorough assessment of the clinical syndrome, optimize treatment, assist the follow-up, and facilitate referrals to other specialties depending on the chief complaint. A systematic assessment might combine several tools, but the optimal ones and the exact usage is unknown. In this narrative review, we are flipping through the literature presenting the available tools per domain for the assessment of quality of life in men on testosterone replacement therapy and we discuss the optimal usage.

Linking testosterone to men’s health

“…Low testosterone levels might lead to unfavorable lipid profiles, with increased LDL cholesterol and decreased HDL cholesterol, which are known risk factors for cardiovascular disease. [7] Testosterone helps in maintaining lean muscle mass and reducing fat accumulation. Low testosterone levels have been linked to an increase in body fat and a decrease in muscle mass, both of which are associated with an elevated risk of cardiovascular disease.…”

“…Testosterone levels should always be tested before testosterone therapy is begun. [7] However, some practitioners will not initiate testosterone therapy if testosterone is only marginally below normal levels (less than 300 ng/dL) if no symptoms are present. [9]…”

“…Intramuscular injections are usually twice a month but usually do not offer consistent sustained blood levels. [7] Intramuscular injections are the preferred method for most insurance due to the lower cost associated with this form of therapy. [7] Transdermal doses are typically intended to be replacement doses, with the patch being administered at a dose of 5-10 mg T/day and gel administration involving a somewhat greater amount of testosterone due to lower absorption.…”

“…[7] Intramuscular injections are the preferred method for most insurance due to the lower cost associated with this form of therapy. [7] Transdermal doses are typically intended to be replacement doses, with the patch being administered at a dose of 5-10 mg T/day and gel administration involving a somewhat greater amount of testosterone due to lower absorption. Injection of testosterone typically delivers higher amounts, 50-400 mg every 2-4 weeks.…”

“…Injection of testosterone typically delivers higher amounts, 50-400 mg every 2-4 weeks. [7] Pellets are inserted transdermal in the sacrum area every three to four months. Pellets usually provide the best therapeutic outcomes by achieving a more sustained blood level of testosterone.…”