The concept of "andropause" has recently gained popularity as increasing evidence suggests that aging in men is accompanied by a progressive decline in serum testosterone levels. The pathophysiologic mechanism responsible for this decline is not fully understood. However, perturbations at every level of the hypothalamic-pituitary-gonadal system have been demonstrated. Age is also a strong risk factor for erectile dysfunction (ED). Although it is tempting to conclude that a causal relationship exists between declining androgen levels and ED, our current understanding of the erectile process and the failure of testosterone supplementation to restore erectile function in older men suggest that these processes are independent. Furthermore, the recent availability of effective oral therapies for ED argues against the indiscriminate administration of androgens to elderly men with ED. However, the beneficial effects of testosterone on libido, mood, bone density, and body fat composition may justify its use on an individual patient basis.
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