Link between low testosterone and frailty in elderly men

March 2012

This review discussed the relationship between low testosterone level and frailty in elderly men and evaluated the evidence which shows that testosterone therapy improves the physical functioning and quality of life of elderly frail men with confirmed low testosterone levels.

Key findings

  • Testosterone is important in controlling body composition and maintaining physical strength in older men
  • Low testosterone level (hypogonadism) is linked to frailty – men with lower levels of testosterone are more likely to be frail than men with higher levels
  • Testosterone therapy is beneficial in elderly frail men with low testosterone, as it:
    • Improves lean body mass (muscle) and reduces the proportion of fat mass in the composition of the body
    • Increases strength and improves the physical functioning and metabolism of the body
  • Low testosterone is linked to a higher risk of type 2 diabetes, depression, cardiovascular disease, chronic obstructive pulmonary disease, metabolic syndrome, chronic renal disease, and a higher overall death rate
    • Testosterone therapy may help to improve a number of risk factors for cardiovascular disease by reducing waist circumference, improving the blood lipid (cholesterol) profile, and improving the sensitivity of the body to insulin
  • Low testosterone is common in elderly men with heart failure: 
    • Low testosterone level appears to predict increased risk of death in men with heart failure
    • Testosterone therapy improves body composition, exercise capacity and insulin resistance in men with heart disease.

Source: Saad F. The relationship between testosterone deficiency and frailty in elderly men. Horm Mol Biol Clin Invest 2010;4(1):529-538

Background information

Frailty in aging men is the vulnerable state of being weak in health or body. Frailty can be a sign of approaching onset of disability, and many parts of the body can be affected, including the nervous system, metabolism (chemical functioning of the body), joints, bones and muscles. With the onset of frailty there is likely to be an ongoing decline in physical condition and body composition, including lowered reserves, weight loss, diminished activity and mobility, sensitivity to change and deterioration in nutritional status, mental processes and endurance.

Frail older adults are at greater risk of becoming ill or dying than non-frail individuals of the same age group. As testosterone has a profound effect on body composition and is a key hormone necessary for maintaining bone mineral density, testosterone therapy may have a particular role to play in frail older men with confirmed low testosterone levels.

This review demonstrated that, although frailty is a complex condition, there is evidence to show that testosterone therapy benefits frail elderly men with low testosterone by improving body composition, bone strength, physical functioning and cardiovascular health.