From the title one might expect a distillation from popular magazines devoted to male fitness and narcissism. In fact the book emanates from the International Society for the Study of the Aging Male. I received it with curiosity mixed with guilt—the former because I wondered what a specific textbook could offer over and above established textbooks of medicine; the latter the guilt of one who has lapsed. Anticipation was quickly overtaken by the controlled panic of clinical self-doubt: could the seemingly all-pervasive presence of androgenic matters be pointing to a major black hole in a ‘mature’ clinical repertoire? Though I can claim my fair share of clinical coups in older men complaining vaguely of being tired all the time—coeliac disease, myasthenia gravis, and a meningioma, to name just a few—never have I diagnosed an ‘andropause’. Discreet questioning of unequivocally able colleagues suggests I am not alone.
Androgens clearly have interesting roles, but the multiple accounts of androgenic pathophysiology scattered throughout this book are cumulatively unconvincing as well as repetitive. To judge from these accounts, a person answering a multiple-choice question on the symptoms of androgen deficiency would best go for the option ‘all of the above’. There seems to be no consensus on reference values for adrenal androgens. The question posed, ‘Does visceral adiposity induce low levels of testosterone, or do low levels of testosterone induce visceral adiposity?’ simply led me to wonder idly about the role of lager and other male secular comforts. As to be expected in a multiauthor book, some of the contributors provide good well-rounded accounts—for example, the substantial chapters on the genitourinary system and the concise and well written account of hair disorders. This is not, however, a comprehensive text, and matters such as Parkinson's disease, accidents, suicide, stroke, amputation and rehabilitation are notably absent, contrary to the medical experience of ageing men. The final chapter, on hormone treatments and preventive strategies, is overwhelmingly and unacceptably dominated by androgens. 69 references largely relate to androgens, yet a discussion of melatonin, which suggests that ‘Insomnia observed in some elderly people can be partially restored by administering Melatonin’, is based on trials that are not referenced. The prescribing advice does not feel robust—for UK readers, not NICE at all.
A textbook addressing a defined field such as this should provide a balanced account and the editors should condense the material, where possible, to provide a coherent narrative. I cannot recommend this work, but for a second opinion I showed it to two third-year medical students. After dipping into and out of it over several lazy summer days they were more positive, suggesting that they would use it if it were in their library; so it may have a place. I am sure androgens themselves have a place in a text on this subject, but the promised future editions should corral them into a single coherent account and widen the horizons.