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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 February 2015

Testosterone and Weight Loss - the Evidence

Testosterone and Weight Loss - the Evidence

Lowered testosterone in male obesity: mechanisms, morbidity and management. Ng Tang Fui M, Dupuis P, Grossmann M. Asian journal of andrology. 2014;16(2):223-231.

Testosterone and weight loss: the evidence. Traish AM. Current opinion in endocrinology, diabetes, and obesity. 2014;21(5):313-322.

Testosterone as potential effective therapy in treatment of obesity in men with testosterone deficiency: a review. Saad F, Aversa A, Isidori AM, Gooren LJ. Current diabetes reviews. 2012;8(2):131-143.

The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. Saad F, Gooren LJ. Journal of obesity. 2011;2011.

It is well documented that obesity may cause hypogonadism, and that hypogonadism may cause obesity. This has generated debate about what condition comes first; obesity or hypogonadism? And what should be the first point of intervention?

In this editorial we summarize data from several reviews on the association of obesity and hypogonadism, and make the case that obesity and hypogonadism create a self-perpetuating vicious circle. Once a vicious circle has been established, it doesn’t matter where one intervenes; one can either treat the obese condition or treat hypogonadism first. The critical issue is to break the vicious circle as soon as possible before irreversible health damage arises.

Nevertheless, as we will explain here, treating hypogonadism first may prove more effective in that it to a large extent “automatically” takes care of the excess body fat and metabolic derangements, and also confers psychological benefits that will help obese men become more physically active. Thereby, restoring testosterone levels in hypogonadal obese men will relatively quickly break the self-perpetuating vicious circle, and transform it into a “health promoting circle.”

5 September 2014

Effects of testosterone replacement therapy in men with hypogonadism

Effects of testosterone replacement therapy in men with hypogonadism

STUDY: Traish AM. Outcomes of testosterone therapy in men with testosterone deficiency (TD): part II. Steroids. 2014;88:117-126.

Alleged concerns regarding risk of cardiovascular disease with testosterone replacement therapy have been promulgated recently. However, a large and growing number of intervention studies show to the contrary that testosterone therapy reduces cardiovascular risk factors and confers multiple beneficial health effects. Thus, fears promoted by some recent flawed studies need to be critically re-evaluated.

This summary gives an overview of a comprehensive review of studies that have investigated health effects and safety of testosterone therapy. As outlined here, the position that hypogonadism (also known as testosterone deficiency) should be regarded as a risk factor for cardiovascular disease is supported by a rapidly expanding body of evidence.


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