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Andropause has a profound effect on prostate function, even though many mechanisms related to testosterone and prostate physiology are unclear. The most worrisome aspect in andropause evaluation is prostate cancer, which is an absolute contraindication for androgen treatment. Early detection of prostate cancer using prostate-specific androgen (PSA) measurement and digital rectal examination (DRE) findings should be offered to men at high risk (those with a positive family history and/or of African- American ethnic background) who are older than 40 years of age and who have at least a 10-year life expectancy. Patients contemplating testosterone replacement therapy should have prostate screening (DRE and PSA measurement) before initiating therapy and then at six-month intervals. Men with abnormal DRE or PSA findings, or those with the presence of prostatic intraepithelial neoplasa on biopsy are not suitable for this treatment.
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