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Male reproductive health and ageing 

Male reproductive health and ageing
Chapter:
Male reproductive health and ageing
Author(s):

David J. Handelsman

DOI:
10.1093/med/9780199235292.003.0128
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date: 19 June 2019

Since antiquity, the waning of male virility with age and the seemingly inexhaustible repertoire of remedies to stave if off have been intertwined human interests in the vain quest for immortality. Advancing age impacts on all aspects of male reproductive health—
sexuality, fertility and androgenization. Increasing longevity throughout society creates a compelling need to promote healthy ageing. The resemblance between some features of ageing and those of younger androgen-deficient men, whose disabilities are readily corrected by testosterone replacement, has long raised interest in whether biochemical androgen deficiency in older men contributes actively to their somatic ageing rather than representing simply a passive barometer of health, or an epiphenomenon of the parallel age-related deterioration of the reproductive with nonreproductive systems. However, if declining androgen secretion with advancing age is clinically significant, or even if it can be overcome pharmacologically, androgen therapy has the potential to improve quality of life for older men. Unlike women where menopause demarcates abruptly the virtually complete cessation of gonadal steroid secretion, male reproductive senescence is a gradual, progressive, but inconsistent and incomplete process varying markedly between individuals in tempo and severity, and accentuated by concomitant ill health. Congruent with wider medical priorities in care of the aged, the goal of management is to coexist with, rather than to eradicate, degenerative diseases. More realistic goals are to improve physical and mental functioning and quality of life so as to prolong enjoyable, independent living, to prevent the preventable, and to delay the inevitable.

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