Gonadal function in old age
• Post-menopausal osteoporosis: a major public health
issue due to the high incidence of associated fragility
fractures, especially of hip.
• Hormone replacement therapy: should only be prescribed
above the age of 50 for the short-term relief of symptoms of
oestrogen deficiency.
• Sexual activity: many older people remain sexually active.
• ‘Male menopause’: does not occur, although testosterone
concentrations do fall with age. Testosterone therapy
in mildly hypogonadal men may be of benefit for body
composition, muscle and bone. Large randomised trials are
required to determine whether benefits outweigh potentially
harmful effects on the prostate and the cardiovascular
system.
• Androgens in older women: hirsutism and balding occur. In
the rare patients in whom androgen levels are elevated this
may be pathological, e.g. from an ovarian tumour.
This infiltrative dermopathy occurs in fewer than 10%
of patients with Graves’ disease and has similar pathological
features as occur in the orbit. It takes the form of
raised pink-coloured or purplish plaques on the anterior
aspect of the leg, extending on to the dorsum of the foot
. The lesions may be itchy and the skin may have
a ‘peau d’orange’ appearance with growth of coarse
hair; less commonly, the face and arms are affected.
Treatment is rarely required, but in severe cases topical
glucocorticoids may be helpful.
• Post-menopausal osteoporosis: a major public health
issue due to the high incidence of associated fragility
fractures, especially of hip.
• Hormone replacement therapy: should only be prescribed
above the age of 50 for the short-term relief of symptoms of
oestrogen deficiency.
• Sexual activity: many older people remain sexually active.
• ‘Male menopause’: does not occur, although testosterone
concentrations do fall with age. Testosterone therapy
in mildly hypogonadal men may be of benefit for body
composition, muscle and bone. Large randomised trials are
required to determine whether benefits outweigh potentially
harmful effects on the prostate and the cardiovascular
system.
• Androgens in older women: hirsutism and balding occur. In
the rare patients in whom androgen levels are elevated this
may be pathological, e.g. from an ovarian tumour.
Pretibial myxoedema
This infiltrative dermopathy occurs in fewer than 10%
of patients with Graves’ disease and has similar pathological
features as occur in the orbit. It takes the form of
raised pink-coloured or purplish plaques on the anterior
aspect of the leg, extending on to the dorsum of the foot
. The lesions may be itchy and the skin may have
a ‘peau d’orange’ appearance with growth of coarse
hair; less commonly, the face and arms are affected.
Treatment is rarely required, but in severe cases topical
glucocorticoids may be helpful.
