A practical guide to diagnosis, management and treatment of testosterone deficiency for Canadian physicians

Abstract

The percentage of men receiving appropriate management for testosterone deficiency syndrome (TDS) is small in comparison to prevalence estimates. This is despite linkages to cardiovascular disease, osteoporosis, diabetes, sexual function, sarcopenia, emotional well-being and the metabolic syndrome. Furthermore, the availability of guidelines has not significantly enhanced the care of TDS patients. A multidisciplinary group of medical experts sought to improve the management of testosterone-deficient patients by Canadian physicians. This report describes their conclusions and defines an algorithm for appropriate TDS management. RésuméLe pourcentage d'hommes recevant une prise en charge appropriée pour un syndrome de carence en testostérone est faible en comparaison avec les taux de prévalence évalués, et ce, malgré le lien entre ce syndrome et les maladies cardiovasculaires, l'ostéoporose, le diabète, la fonction sexuelle, la sarcopénie, le bien-être émo-tionnel et le syndrome métabolique. Par ailleurs, la publication de guides de pratique n'a pas amélioré de façon significative les soins offerts aux patients atteints du syndrome de carence en testostérone. Une équipe multidisciplinaire de médecins a tenté d'améliorer la prise en charge des patients atteints de ce syndrome par les médecins canadiens. Le présent rapport décrit leurs conclusions et propose un algorithme de prise en charge.

Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline

“…3 A Canadian publication authored by physicians of various in- terests and backgrounds, but aimed primarily at urologists, appeared in 2010. 27 Neither of these latter two publications used a recognized system for evaluation of the evidence.…”

Predicting low testosterone in aging men: a systematic review

“…When available, the bioavailable testosterone measurement was the preferred basis for diagnosis because it is considered by many to be most accurate. 12 If bioavailable testosterone was unavailable, we used total testosterone, and if neither of these was available we used free testosterone. Although free testosterone measured by equilibrium dialysis is considered highly accurate, calculated free testosterone values vary depending on the formula used, 13 and analogue methods of measurement are recognized as having poor accuracy.…”

Androgens are Fundamental in the Maintenance of Male Sexual Health

“…This manifestation is recognized as the early warning of hypogonadism, while decreased erectile function (in the absence of other more prominent causes) appears to occur only in the presence of profound T deficiency [36]. There are other manifestations of androgen deficiency not pertinent to this review.…”

“…The Endocrine Society Guideline suggested TTH "to men with ED who have low T" [36], but it is not specific as to the issue of initially ruling out the presence of hypogonadism in all men with ED. Hypogonadism rarely is the main etiological factor in ED, much less the single factor, but as emphasized earlier, it cannot be ruled out by history and physical examination alone.…”