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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.

15 October 2017

UK policy statements on testosterone deficiency

UK policy statements on testosterone deficiency

Hackett G, Kirby M, Edwards D, Jones TH, Rees J, Muneer A. UK policy statements on testosterone deficiency. Int J Clin Pract. 2017;71(3-4).

Testosterone deficiency (also known as hypogonadism) and its treatment is a medical issue that has long been neglected, despite causing significant physiological and psychological health complications among affected men. Longstanding dogmatic fears about prostate cancer and more recent misleading studies alluding to heart attack and stroke risk, has made testosterone treatment a controversial topic.

Here we summarize the newly published UK policy statements on testosterone deficiency, which are based on an International expert consensus conference on testosterone deficiency and its treatment. These statements, developed by the British Society for Sexual Medicine, address widespread media and scientific concerns over the appropriate treatment of testosterone deficiency with testosterone therapy.

Key Points

British Society for Sexual Medicine (BSSM) policy statements on testosterone deficiency:
  1. Testosterone deficiency is a well-established, significant medical condition.
  2. Testosterone deficiency has well-established symptoms.
  3. Testosterone therapy for men with testosterone deficiency is effective, rational and evidence based.
  4. There is no scientific basis for withholding testosterone therapy from men on the basis of age.
  5. Testosterone deficiency is associated with increased cardiovascular and all-cause mortality.
  6. The evidence does not support an increased cardiovascular risk associated with testosterone therapy.
  7. There is no evidence that supports any increase in the risk of prostate cancer with testosterone replacement therapy.
  8. A major research initiative to explore the benefits of testosterone therapy in cardiometabolic disease is overdue.

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