The Society’s Clinical Practice Guidelines for Testosterone Replacement Therapy in Hypogonadal Men recommend appropriate testing and prescribing practices.
1. Emphasis should be placed on getting an accurate diagnosis from a clinician.
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Diagnosis of hypogonadism requires confirmation of symptoms of low testosterone and consistently low blood total and free testosterone accurately measured by laboratory tests. The diagnostic approach and definitions are the same for men of any age.
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Terms such as “age-related,” “late-onset,” and “functional” hypogonadism are difficult to operationally define, blurring the line between treatable disease and normal aging.
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Hypogonadism cannot be diagnosed based on symptoms alone. Decreased energy, sex drive, and mood are common in older men due to a variety of causes. Healthcare providers must first rule out reversible factors, such as obesity and medications such as corticosteroid or opioid use.
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Testosterone replacement therapy (TRT) at doses similar to those normally taken by men has clear benefits for men with properly diagnosed hypogonadism and diseases affecting the testicles, pituitary gland, or hypothalamus as a cause.
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If hypogonadism due to overweight or obesity (BMI > 27) is properly diagnosed and no other cause has been identified, weight loss is usually the first-line treatment.
2. Although recent studies have addressed some concerns, further research is needed to fully understand the risks of TRT.
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Screening and monitoring are required when starting testosterone therapy. Risk assessment before starting treatment and careful monitoring during treatment remain essential because prostate cancer is slow-growing and trials may not be following men well.
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The association is calling for a long-term “Men’s Health Initiative” similar to the Women’s Health Initiative to fill evidence gaps.
3. Consistent diagnosis and testing quality ensures that men who need treatment get it.
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Using a testosterone assay certified by the CDC HoST program ensures that the assay is standardized and “harmonized.” Harmonization is the process of smoothing out differences, so results from testosterone assays certified by the CDC are similar. This is very important because many testosterone assays are inaccurate, have highly variable results, and have inadequate normal (reference) ranges.
