There is virtually no correlation between what are generally accepted to be the symptoms of deficient androgen in
men and levels of androgens as measured in the laboratory. Now that androgen deficiency is being shown to play a part in
conditions as diverse as metabolic syndrome, diabetes, and coronary heart disease, a hypothesis is needed to explain this apparent
discrepancy between measured androgen levels and our understanding of the symptoms of androgen deficiency.
When the possible mechanisms for androgen actions are considered, one explanation emerges that androgen may act
much like insulin in persons with type 2 diabetes mellitus: the degree of androgen resistance may be variable depending
on the organs or systems considered. Therefore, the symptoms can result from altered or damaged synthesis of androgen
synthesis or regulation, elevated androgen binding, a reduction in tissue response, or decreased as a result of polymorphism
and aging. Genomic transcription and translation may also be affected.
As with diabetes, in adult male androgen deficiency, it is suggested that the definition of androgen deficiency should be
based on individual physiology, with the requirements of the individual at a particular stage of life setting the baseline
against which any deficiency of androgens or androgen metabolites, either absolute or relative, is determined. This approach
will affect the terminology, etiology, diagnosis, and treatment of androgen deficiency.
Keywords: Aging, androgen, androgen deficiency, DHEA, diabetes, erectile dysfunction, insulin, polyglutamine, sex hormone
binding globulin (SHBG), testes, testis, testosterone, testosterone deficiency.
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