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Age-related hypogonadism is a clinical syndrome defined as a low serum testosterone level (< 11 nmol/l) with precise clinical symptoms: diminished libido, erectile dysfunction, and loss of morning erection. Testosterone supplementation has been shown to have a beneficial effect on muscle and fat mass as well as on bone mineral density, with more conflicting effects observed on muscle strength, sexual function, mood and quality of life. In spite of an inverse relationship between testosterone levels and various cardiovascular risk factors (obesity, insulin resistance and type 2 diabetes mellitus), there is no evidence of a positive effect of testosterone replacement therapy towards these risk factors. So far, the long-term safety of testosterone replacement therapy has not been established. Evidence has been found that testosterone replacement therapy has a causative and worsening role in prostate cancer urging not to treat patients with a history of prostate cancer. Finally, patients with high cardiovascular risk, including those with congestive heart failure, should not be treated.