PADAM(Partial Androgen Deficiency in the Aging Male) and Hormone Replacement Therapy

Kim, Je Jong

Abstract

PADAM is defined by International Society for the Study of the Aging Male(ISSAM) as a biochemical syndrome associated with advancing age and characterized by a deficiency in serum androgen with or without decreased tissue sensitivity to androgen. The precise role of androgens in the aging process of men remains unclear, and there have been few controlled clinical studies in aging men to investigate the effects of androgen replacement therapy on various organs and human functions known to deteriorate with age(except for studies on muscle and bone). These organs and functions include the mind, the cardiovascular system, the immune system, and the composition of body fat. In addition, the effect of androgen replacement therapy on the prostate is very important in terms of its safety in aging men. Good randomized, double-blind, placebo-controlled clinical studies in the aging male are clearly lacking. We need studies that can help us better understand the effect of long-term androgen replacement therapy(both with testosterone and DHEA) on important aspects of men's health: cardiovascular disease, body composition, cognition and dementia, osteoporosis, and the prostate. Until such data will become available(probably not for the next decade), we recommend a careful and individualized evaluation of present health problems combined with assessment of prostatic health(rectal examination, transrectal ultrasound, and PSA measurement), cardiovascular health, and cerebral status(including overall quality of life) be undertaken before androgen replacement is initiated. Treatment should be monitored by the same criteria. The future will probably bring the development of 'designer androgens' with(ideally) beneficial effects on the cardiovascular system, bone, muscle, fat tissues, and brain, and simultaneous neutral or even inhibitory effects on the prostate. The onset of PADAM is unpredictable and its manifestations are subtle and variable, which has led to a paucity of interest in its diagnosis and treatment. Urological practice commonly includes a large proportion of men older than 50 years. Therefore, it is important for urologists to recognize the manifestations of PADAM and be familiar with evaluations necessary to document, monitor, and treat it.