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RESULTSThe mean (range) level of testosterone before supplementation was 5.2 (1.1-9.2) nmol/L and the duration of follow-up while on supplementation was 14.5 (6-27) months. At the last visit, the testosterone levels were 17.6 (8.5-32.4) nmol/L. One of the five patients had a transitory increase in PSA level but none had levels of > 1.5 ng/mL. All patients reported a marked response in the manifestations of TDS, i.e. four each reported decreased hot flushes, decreased fatigue and improved libido, and two reported improved erectile function. CONCLUSIONMen with TDS after EBRT for localised prostate cancer are candidates for testosterone therapy. The patients must be aware of the advantages and disadvantages of the treatment. PSA levels must have reached a nadir before starting treatment and the follow-up must be particularly close. In these few patients there were no adverse effects from testosterone supplementation. There is a need for more information about the safety and efficacy of testosterone therapy in men successfully treated for localized prostate cancer, because there is evidence indicating hypogonadism in these patients, compromising their quality of life and longevity, independent of the cancer. KEYWORDStestosterone, prostate cancer, radiotherapy Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo assess the effects of testosterone supplementation in men with testosterone deficiency syndrome (TDS) after external beam radiotherapy (EBRT) for localized prostate cancer. PATIENTS AND METHODSFive men with significant signs of TDS after treatment for localized prostate cancer with EBRT were treated with testosterone once their prostate-specific antigen (PSA) level had reached the nadir.

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This study confirms that newer, more complex tools perform similarly to the simpler ADAM questionnaire. The lack of correlation between the clinical picture and the most commonly used biochemical confirmatory tests, again, clearly points to the paramount importance of the clinical evaluation. An emphasis and reliance on serum T alone hinders the clinician's ability to manage testosterone deficiency syndromes (TDS).

This study did not suggest a clinical benefit of OTU or DHEA supplementation in men with hypoandrogenism and SD. The recommended dose of OTU may have been inadequate or poorly absorbed. Increased doses or an alternative T delivery form may result in a different response.