Although hormonal replacement therapy (HRT) for postmenopausal women has been studied, discussed, and practiced for years, there has been much less focus on hypogonadal disorders of the adult male and male HRT. This is manifested both in clinical practice, where the symptoms of adult hypogonadism in the male are often attributed to other problems, denied by the patient, and underrecognized by the physician, and in research, which has produced few data on the long-term risks and benefits of androgen replacement therapy in middle age and beyond. The use of testosterone therapy to prevent or reverse aspects of male “andropause” is a topic of growing interest. This article reviews the presentation and diagnosis of hypogonadism in the adult male, presents the current state of knowledge on the issue of HRT for the older male, and discusses treatment options and management.