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

Abstract

The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age globally. One in four persons living in Europe and Northern America will be aged 65 or over. One of the goals of ISSAM is to raise awareness of the special health needs of older men. Since a significant number of aging men will eventually become testosterone deficient, the Hypogonadism panel of ISSAM updates its guidelines.

Testosterone Treatment (TTh) Improves Anemia and Hematocrit Increase Reduced Death in Hypogonadal Men: Paradigm Shift of a Risk Factor of TTh

“…This confirms the current clinical guidelines recommendation of using 54% as a threshold for change in management of men receiving testosterone therapy (e.g. dose reduction or therapeutic phlebotomy) [11][12][13][14][15]. It should be kept in mind that dehydration can cause a temporary elevation in hematocrit [16] and therefore a high hematocrit reading should be confirmed in a second blood test, ensuring the patient is in a well hydrated state, before action is taken.…”

The role of clomiphene citrate in late onset male hypogonadism

“…Unlike women, men do not show a cessation of hormone production, but rather a gradual decrease of 40 years of age. This leads to a deficiency of androgens (10)(11)(12), which can compromise both the quality of life and the functioning of certain organs (3)(4)(5). It is already well established that this decrease in testosterone (TT) can cause sarcopenia, muscle weakness, increased adipose tissue, fatigue, lack of motivation, depression, irritability, anemia, lower memory, and reasoning ca-pacity.…”

“…The decrease in total testosterone occurs in a rate of 1% per year and free testosterone, 2% per year, from the age of 40. This decrease is due to a smaller number and minor function of Leydig cells, changes in the hypothalamus-pituitary-gonadal axis and increased sex hormone binding globulin (SHBG) (3,4,10). Hypogonadism in aging is also associated with increased body weight and adipose tissue, resulting from peripheral conversion of testosterone into estradiol, and the negative feedback from estradiol in the pituitary gland results in a low LH secretion despite a low testosterone level.…”

“…homeostasis of the organism but also its psychological function (3)(4)(5). Currently, the most common treatment of symptomatic LOH is testosterone therapy with various options of administration: transcutaneous, buccal, oral or intramuscular.…”

Maintenance of androgen deprivation therapy or testosterone supplementation in the management of castration-resistant prostate cancer: that is the question

“…Unfortunately, the generalization of the study results was hampered by 2 major limitations: (1) the study was early interrupted when 1/3 of planned patients were enrolled, (2) only 7% of patients randomized to ADT withdrawal achieved a serum testosterone level >0.5 ng/ml in the offtherapy phase, in contrast with the reported time to testosterone normalization of about 3 months in HSPC patients in the off phase of intermittent ADT schedules [12]. Testicular atrophy, due to the long-term ADT exposure in the majority of the PON-PC patients, could be a plausible explanation for this phenomenon [13][14][15].…”