Data strongly suggests a relationship between testosterone deficiency and frailty in elderly men
The relationship between testosterone deficiency and frailty in elderly men. Saad F. Horm Mol Biol Clin Invest 2010;4(1):529-538.
This review aimed to discuss the relationship between low testosterone level and frailty in elderly men and to evaluate the data which show that treatment of frail hypogonadal men with testosterone therapy improves physical functioning and reduces some common risk factors for cardiovascular disease.1
What is known
Frailty in aging men is the vulnerable health condition characterized by a cumulative decline in body composition and function, including decreased reserve, weight loss, diminished activity and mobility, sensitivity to change and a deterioration in nutritional status, cognition and endurance.1-3 Often a forerunner to the onset of overt disability, aspects of frailty are related to the neurological system, metabolism, joints, bones and muscles. Frailty in older adults is associated with increased morbidity and mortality; in one study in over 5000 subjects aged 65 years or over, frail individuals had a death rate almost double that of those classified as intermediate frail, and over three times that of non-frail individuals.2 Sarcopenia (the age-related loss of skeletal muscle mass, strength and function) and diminished bone mineral density are major determinants of frailty.3 As testosterone has a profound effect on body composition and is a key hormone necessary for the maintenance of bone mineral density, testosterone therapy may have a role in the management of frail older men with confirmed low testosterone levels.
What this study adds
This review demonstrated that, although frailty is a complex condition, the evidence suggests that testosterone therapy in frail elderly men with low testosterone level improves body composition and axial bone mineral density and physical function while ameliorating a number of risk factors for CVD. Although frailty is a composite syndrome and not all aspects of frailty will be ameliorated by testosterone therapy, available data strongly suggest a relationship between testosterone deficiency and frailty and warrant further investigation to determine those frail elderly men most likely to benefit from testosterone therapy and to define the role of testosterone therapy in the management of elderly men with frailty.