For guys without hypogonadism, a wait-and-see approach may make the most sense. "We just don't have the data to prove that raising testosterone in men who already have normal levels confers any real benefit," says Dr. Robert Mordkin , a urologist in Arlington, Virginia. Furthermore, Mordkin adds, "Natural waxes and wanes of testosterone as we age may have some not yet entirely understood protective effects." In addition to making us better fathers, as the Northwestern study infers, declining testosterone "may lower our vulnerability to prostate cancer at a time in our lives when we're at the greatest risk for it." That said, if you have classic symptoms of hypogonadism – low libido, fatigue, erectile dysfunction – "it's probably reasonable to check your testosterone. And for those guys whose blood levels come under definitions of low testosterone, it's probably reasonable to try the therapy for a while. But that's very different from saying testosterone is the fountain of youth."
A 31-year-old man presenting with an 18-month history of sexual dysfunction resulting from severe adult-onset IHH (LH U/L, FSH U/L, T nmol/L). Initial therapy with 50 mg of clomiphene citrate (CC) three times a day for 7 days, with overnight LH pulse profiling and 9 am T levels evaluated at baseline and on completion. A 2-month washout period, followed by low-dose maintenance therapy (25-50 mg/d) for 4 months.
MAIN OUTCOME MEASURE(S):Baseline and stimulated T levels and LH pulsatility; effect on sexual function.
RESULT(S):Clomiphene therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. CONCLUSION(S):Isolated hypogonadotropic hypogonadism may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential. On theoretical grounds, reversal of gonadotropin deficiency with CC might be expected to have a similar biological effect.
Calcium alone or in combination with vitamin D reduces fracture risk by 12 percent in men and women 50 years and older (NNT = 63). 26 The Food and Nutrition Board at the Institute of Medicine has established a daily intake for calcium and vitamin D sufficient to maintain bone health and normal calcium metabolism in healthy persons. 27 The calcium intake in men older than 50 years is 1,200 mg. The vitamin D intake in men 51 to 70 years of age is 400 IU, and in men older than 70 years is 600 IU. However, the recommended intake for preventing osteoporotic fractures is at least 800 IU per day. 26 Most experts agree that the goal is to maintain serum 25-hydroxyvitamin D levels above 30 ng per mL ( nmol per L). 28