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15 May 2018

Clinical Practice Guidelines on Diagnosis and Treatment of Hypogonadism – important issues

Clinical Practice Guidelines on Diagnosis and Treatment of Hypogonadism – important issues
Clinical practice guidelines on hypogonadism and testosterone therapy aim to help clinicians diagnose and treat men who present with hypogonadism. However, due to lack of scientific data on several issues, guidelines recommendations inevitably contain an element of opinion, which is why there are contradictions between some recommendations issued by different guidelines.

Confusion is particularly common regarding what is considered “low testosterone”, or more precisely, the diagnostic testosterone thresholds. However, this should not be interpreted as a problem because it is acknowledged that in clinical practice there are men who have total testosterone levels above 12 nmol/L (~350 ng/dL) who are highly symptomatic and who have experienced symptom/sign improvement with testosterone therapy. Support for this comes from physician experts with long clinical experience of diagnosing and treating testosterone deficiency, who all agree that symptoms should be the primary consideration in the diagnosis of testosterone deficiency.

We provide a commentary summarising research, to help physicians make an informed decision. Another debated topic is the potential of weight loss to treat hypogonadism. However, several studies refute this by showing that the small elevation in testosterone levels after weight loss in not enough to alleviate symptoms of testosterone deficiency and its symptoms.

Last updated: 2019
G.MKT.GM.MH.02.2018.0506