How to manage low testosterone level in men: a guide for primary care

Al-Sharefi, Ahmed; Wilkes, Scott; Jayasena, Channa N.; Quinton, Richard

doi:10.3399/bjgp20x710729

Cited by 5 publications

(11 citation statements)

References 5 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, a pragmatic approach to evaluating calculated free T would acknowledge that, whilst it is unlikely to provide an accurate measurement of actual circulating unbound T, studies have found it to correlate better than total T with several biological read-outs of androgen action, including bone density [35], sexual function [36], and haematopoeisis [37]. However, where SHBG level is mid-range, the calculation adds little added value [21].…”

Section: Approach To Low-borderline Serum T Valuementioning

confidence: 99%

“…Surprisingly little weight is given by any guideline to the key significance of a raised LH level-a finding that not only highlights an unequivocal defect of Leydig cell function, but also usefully excludes physiological NGI and venepuncture mistiming as a cause of lower serum T-or of a high-normal hemoglobin or hematocrit (Hct), which indicates that testosterone treatment will necessarily carry an unacceptably high risk of inducing erythrocytosis [21].…”

Section: Indications For Testosterone Treatmentmentioning

confidence: 99%

“…Thus, for men predisposed to developing erythrocytosis, it may prove necessary to accept lower serum T in order to mitigate risks of thrombosis or venesection. In contrast, for younger men with anemia, or low bone density, achieving a higher level is probably justified [21].…”

Section: Monitoring Testosterone Therapymentioning

confidence: 99%

“…Moreover, whereas almost all guidelines recommend aiming for a mid-range serum T level, they universally fail to explicitly articulate the importance of qualifying this advice with the necessary contextual prefix “other things being equal.” Thus, for men predisposed to developing erythrocytosis, it may prove necessary to accept lower serum T in order to mitigate risks of thrombosis or venesection. In contrast, for younger men with anemia, or low bone density, achieving a higher level is probably justified [ 21 ].…”

Section: Monitoring Testosterone Therapymentioning

confidence: 99%

“…Although the benefits and safety profile of using testosterone to treat well-found MH are well-established, its use in men without a verified diagnosis of hypogonadism carries significantly less reassurance [21]. In fact, older or obese men receiving testosterone therapy outside the umbrella of organic hypogonadism may be at risk of developing secondary polycythemia, CV disease and detection of subclinical prostate cancer [22,23], not to mention androgen-induced hypogonadotropic infertility.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Al-Sharefi

Quinton

2020

Endocrinol Metab

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Approach To Low-borderline Serum T Valuementioning

confidence: 99%

Section: Indications For Testosterone Treatmentmentioning

confidence: 99%

Section: Monitoring Testosterone Therapymentioning

confidence: 99%

Section: Monitoring Testosterone Therapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Al-Sharefi

Quinton

2020

Endocrinol Metab

Self Cite

View full text Add to dashboard Cite

show abstract

Lessons learnt from the variation across 6741 family/general practices in England in the use of treatments for hypogonadism

Heald

Stedman²,

Whyte

et al. 2021

Clinical Endocrinology

View full text Add to dashboard Cite

Introduction We have previously reported rates of diagnosis of male hypogonadism in United Kingdom (UK) general practices. We aimed to identify factors associated with testosterone prescribing in UK general practice. Methods We determined for 6741 general practices in England, the level of testosterone prescribing in men and the relation between volume of testosterone prescribing and (1) demographic characteristics of the practice, (2) % patients with specific comorbidities and (3) national GP patient survey results. Results The largest volume (by prescribing volume) agents were injectable preparations at a total cost in the 12‐month period 2018/19 of £8,172,519 with gel preparations in second place: total cost £4,795,057. Transdermal patches, once the only alternative to testosterone injections or implants, were little prescribed: total cost £222,022. The analysis accounted for 0.27 of the variance in testosterone prescribing between general practices. Thus, most of this variance was not accounted for by the analysis. There was a strong univariant relation (r = .95, P < .001) between PDE5‐I prescribing and testosterone prescribing. Other multivariant factors independently linked with more testosterone prescribing were as follows: HIGHER proportion of men with type 2 diabetes(T2DM) on target control (HbA1c ≤ 58 mmol/mol) and HIGHER overall practice rating on the National Patient Survey for good experience, while non‐white ethnicity and socio‐economic deprivation were associated with less testosterone prescribing. There were a number of comorbidity factors associated with less prescribing of testosterone (such as T2DM, hypertension and stroke/TIA). Conclusion Our analysis has indicated that variation between general practices in testosterone prescribing in a well developed health economy is only related to small degree (r2 = 0.27) to factors that we can define. This suggests that variation in amount of testosterone prescribed is largely related to general practitioner choice/other factors not studied and may be amenable to measures to increase knowledge/awareness of male hypogonadism, with implications for men's health.

show abstract

Male hypogonadism and general practitioners in the UK. How to increase case recognition, without compromising diagnostic accuracy?

Jayasena

Quinton

2021

Clinical Endocrinology

Self Cite

View full text Add to dashboard Cite

How to manage low testosterone level in men: a guide for primary care

Cited by 5 publications

References 5 publications

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

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

Lessons learnt from the variation across 6741 family/general practices in England in the use of treatments for hypogonadism

Male hypogonadism and general practitioners in the UK. How to increase case recognition, without compromising diagnostic accuracy?

Contact Info

Product

Resources

About