Mini Mental State Examination
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The male reproductive system is composed of several elements including the central nervous system (brain), hypothalamus and pituitary (glands that regulate hormonal function), testicles, and the components that transport and metabolize androgens (male sex hormones). These elements are linked, and essentially cause the functioning of the testicles to produce testosterone and other sex hormones that produce male sexual characteristics and other functions. For example, male hormones are required for the production of sperm, male physical characteristics, and are even required in the production of some blood components, and they also contribute to bone metabolism. Details of testicular function are summarized elsewhere in this volume (‘‘The Testis’’). With increasing age, testicular function often wanes, and it is common for older men to have lower blood concentrations of testosterone and other male hormones, such as those that arise in the adrenal glands. Around half the men aged 70 years and older have reduced levels of these hormones. The effects of low androgen levels include loss of muscle mass and muscle strength, reduced libido and reduced ability to develop and sustain erection of the penis, reduced bone mass, increased osteoporosis, and an impaired sense of well being, often with depression. Testosterone replacement has been used to improve the sense of well being and sexual function. In theory, this should also improve bone mass, and reduce the potential for developing osteoporosis. The most common indications for testosterone replacement therapy in the elderly include symptoms of hypogonadism or measurable testosterone deficit. However, as many elderly men suffer from benign prostatic hyperplasia (see ‘‘The Prostate’’) or prostate cancer (see ‘‘Prostate Cancer’’), testosterone replacement therapy has potential hazard as both conditions are quite sensitive to stimulation by male hormones, such as testosterone. Dehydroepiandrosterone (DHEA), a chemical derived
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Springer-Verlag Berlin Heidelberg 2008
from the adrenal male hormone, androstenedione, is available in health food stores, and is often taken by elderly men as a supplement and stimulant. It is not at all clear that this is a safe practice. There are several available preparations for testosterone replacement therapy, including injections, tablets, cutaneous patches, and a gel. Some physicians believe that it is safer to use short‐acting preparations, in case of adverse effects, although patches and gels are often used for patients on long‐established therapy. When on therapy, side effects should be monitored, including blood work to rule out abnormalities of blood count, liver function tests, and prostate‐specific antigen (PSA) levels (a protein released by prostate cancer and by benign prostatic hyperplasia). Occasionally, testosterone replacement can lead to increased levels, and this may be associated with increased aggression and other abnormalities of behavior. Testosterone replacement therapy should only be used under the care of a physician.
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