Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline.
By S. Bhasin, G. Cunningham, F. Hayes, A. Matsumoto, P. Snyder, R. Swerdloff, Victor M. Montori. Journal of Clinical Endocrinology and Metabolism, 2010
2,033 citations recorded by the source corpus.
OBJECTIVE Our objective was to update the guidelines for the evaluation and treatment of androgen deficiency syndromes in adult men published previously in 2006. PARTICIPANTS The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. CONCLUSIONS We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels. We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test. We recommend confirmation of the diagnosis by repeating the measurement of morning total testosterone and, in some men in whom total testosterone is near the lower limit of normal or in whom SHBG abnormality is suspected by measurement of free or bioavailable testosterone level, using validated assays. We recommend testosterone therapy for men with symptomatic androgen deficiency to induce and maintain secondary sex characteristics and to improve their sexual function, sense of well-being, muscle mass and strength, and bone mineral density. We recommend against starting testosterone therapy in patients with breast or prostate cancer, a palpable prostate nodule or induration or prostate-specific antigen greater than 4 ng/ml or greater than 3 ng/ml in men at high risk for prostate cancer such as African-Americans or men with first-degree relatives with prostate cancer without further urological evaluation, hematocrit greater than 50%, untreated severe obstructive sleep apnea, severe lower urinary tract symptoms with International Prostate Symptom Score above 19, or uncontrolled or poorly controlled heart failure. When testosterone therapy is instituted, we suggest aiming at achieving testosterone levels during treatment in the mid-normal range with any of the approved formulations, chosen on the basis of the patient's preference, consideration of pharmacokinetics, treatment burden, and cost. Men receiving testosterone therapy should be monitored using a standardized plan.
Subfields: Endocrinology, Diabetes and Metabolism, Molecular Biology, Pulmonary and Respiratory Medicine
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Citations in the corpus
- Standards of Medical Care in Diabetes—2013 (2012, background): “The evidence for effects of testosterone replacement on outcomes is mixed, and recent guidelines suggest that screening and treatment of men without symptoms are not recommended (398).”
- Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management (2018, neutral): “102 The potential benefits of testosterone on emotional and physical health usually outweigh the potential side-effects, such as behavioural changes, acne, body odour, rapid growth spurt, and epiphyseal closure.”
- GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength. (2013, background): “As a result, a panel of endocrinologists formulated a strong recommendation against testosterone use in men with prostate cancer and in men pending evaluation of palpable prostate nodule or induration or prostate-specific antigen (PSA) level of 4 ng/mL or PSA level of 3 ng/mL in men at high risk of ”
- Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018, background): “The goal of testosterone therapy is the normalization of total testosterone levels combined with improvement in symptoms or signs.(5,43) The Panel recommends that testosterone treatment programs use the minimal dosing necessary to drive testosterone levels to the normal physiologic range of 450-600 ”