Current National and International Guidelines for the Management of Male Hypogonadism: Helping Clinicians to Navigate Variation in Diagnostic Criteria and Treatment Recommendations

Abstract

Male hypogonadism-rebadged by some as testosterone deficiency syndrome-is a clinical and biochemical diagnosis of increasing worldwide interest. Organic male hypogonadism-usually permanent-is well-established, but aging men may also exhibit lower serum testosterone levels; principally due to burden of extra-gonadal comorbidities such as obesity, diabetes and metabolic syndrome, but with an underlying intact hypothalamo-pituitary-testicular (HPT) axis capable of springing back into operation once comorbidities are addressed. Despite encouraging observational data and plausible theoretical underpinning, evidence for efficacy and safety of testosterone in this "aging" group of men is lacking; addressing comorbid illnesses remains the key priority instead. Nevertheless, in recent years, accumulation of misleading information online has triggered a global tsunami of testosterone prescriptions. Despite this, many men with organic hypogonadism remain undiagnosed or untreated; many more face a diagnostic odyssey before achieving care by the appropriate specialist. As testosterone therapy is not without risk several clinical practice guidelines have been published specialist societies to guide physicians on best practice. However, these are heterogeneous in key areas, reflecting divergent approaches to the same evidence basis. Herein, we navigate the major clinical practice guidelines on male hypogonadism and test their respective recommendations against current best evidence.

Effect of Chronic Heart Failure Complicated with Type 2 Diabetes Mellitus on Cognitive Function in the Elderly

“…The main clinical manifestations are dyspnea, fatigue, pulmonary congestion, and systemic blood stasis, which is an irreversible process of chronic disability and needs long-term treatment [ 21 ]. Diabetes is the most common chronic metabolic disease, which can lead to serious complications of heart, brain, kidney, blood vessels, nerves, and other tissues and organs [ 22 ]. Elderly patients with CHF with diabetes are a special group, which is a serious threat to human health [ 23 ].…”

Recommendations on the diagnosis, treatment and monitoring of testosterone deficiency in men

“…Although the clinical significance of TD in adult men is becoming increasingly recognized, the extent of its prevalence in the general population is still a matter of uncertainty and perhaps underappreciated. A large number of men with TD who would be expected to benefit from testosterone treatment, continue to remain undiagnosed and untreated due to deficient basic knowledge and postgraduate medical training in sexual medicine [7,8].…”

Secondary Polycythemia in Men Receiving Testosterone Therapy Increases Risk of Major Adverse Cardiovascular Events and Venous Thromboembolism in the First Year of Therapy

“…16 Multiple national guidelines use elevation in hematocrit as a trigger to stop or change TT in men. TT cessation triggers include 55% from Canadian guidelines, 9 54% from endocrine society guidelines and European urology guidelines, 5,26 and between 50%–54% from American urological guidelines. 10 While the rationale for these cutoffs is not cited in these guidelines, they appear to come from the Framingham heart study, which found an increase in adverse cardiovascular outcomes with a hematocrit of 49% or higher.…”