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April 23 2008

Effects of Testosterone Therapy in Older Men—Reply

JAMA. 2008;299(16):1900-1901. doi:10.1001/jama.299.16.1900-b

In Reply: Drs Page and Matsumoto have concerns about the interpretation and context for some of the results of our trial. Regarding the study population, we aimed to conduct a study in a group of men for whom there is no absolute indication for testosterone treatment, but rather a “gray zone” where some might advocate use of testosterone as a preventive agent for chronic diseases of late life. That was the reason we chose the 50th percentile of the population distribution as the cutoff for inclusion. There is a gradual decline of testosterone levels with aging, and although not all men in our study were hypogonadal, they certainly had lower testosterone concentrations than men aged 30 years. Epidemiological observational studies show that the decline of testosterone is associated with a number of signs and symptoms of aging over the entire range of testosterone, including concentrations that are not clinically defined as hypogonadal as in our study.1 Moreover, in post hoc subgroup analysis of men with testosterone levels lower than 9.65 nmol/L (to convert to ng/dL, divide by 0.0347), testosterone treatment did not have effects on any of the outcomes in our study.