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Humans and some other primates are unique in having adrenal glands that secrete large amounts of dehydroepiandrosterone and its sulfate ester. 1 In normal subjects there is an age-related decline in dehydroepiandrosterone secretion, 2 – 4 but whether this represents a harmful hormone deficiency or a beneficial age-related hormonal adaptation is not known. Administration of dehydroepiandrosterone to normal elderly men and women has been reported to increase bone density, muscle strength, the sense of well-being, and serum concentrations of insulin-like growth factor I (IGF-I). 5 – 11 However, well-being was not assessed with the use of validated questionnaires, and most studies were open label, so . . .

Testosterone as a compound for the treatment of testosterone deficiency has been available for almost 70  years; however, the pharmaceutical formulations have been less than ideal. Injectable testosterone esters have been used traditionally for treatment, but they generate supranormal testosterone levels shortly after the 2-–3-weekly injections, when testosterone levels then decline very rapidly becoming subnormal in the days before the next injection. Testosterone undecanoate is a new injectable testosterone preparation with a considerably better pharmacokinetic profile. After two initial injections with a 6-week interval, the following intervals between two injections are almost always 12  weeks. Plasma testosterone levels with this preparation are almost always in the normal range. Side effects experienced with conventional testosterone esters are almost nil with this preparation.