Testosterone production declines with age in men. The decline is associated with several risk factors and diseases, including obesity and cardiovascular and metabolic diseases, diminished muscular, cognitive and sexual function and changes in body composition. Androgen treatment in elderly men has mostly been addressed in small short-term studies, and larger long-term investigations with sufficient statistical power are still needed for a proper evaluation of the benefit-risk-ratio of testosterone treatment. Current data do not support testosterone supplementation in healthy, asymptomatic older men with normal or low-normal testosterone levels. Treatment may be beneficial in older men with clear hypoandrogenic symptoms, especially reduced libido, erectile dysfunction and decreased muscle strength, if testosterone concentration is consistently low, and the patient selection, counselling and follow-up are adequate.
