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Late-onset Hypogonadism and Testosterone Therapy – A Summary of Guidelines from the American Urological Association and the European Association of Urology (2019)
Mikkel Fode , Andrea Salonia , Suks Minhas , Arthur L. Burnett , Alan W. Shindel
Abstract
Men with low serum testosterone and symptoms of androgen deficiency may be diagnosed with testosterone deficiency. This condition is associated with metabolic syndrome and cardiovascular disease. The benefits (eg, improvement in sexual function) and risks (eg, prostate cancer and cardiovascular disease) of testosterone therapy are controversial. The American Urological Association and European Association of Urology guidelines on testosterone therapy differ on several points of management, likely reflecting the ambiguities surrounding testosterone therapy in practice. This paper summarizes both guidelines with a focus on the differences between the two sets of guidelines.
Patient summary
The benefits and risks of testosterone therapy are controversial, as reflected in the European Association of Urology and American Urological Association guidelines that differ on several points of management.
7. Goals for future research
Discrepancies between the guidelines reflect limited and conflicting evidence throughout the literature. Future studies should be designed with the intent of defining biochemical thresholds and elucidating the true clinical relevance of free T. Exploration of the effects of TT on overall QOL and identification of men with sexual dysfunction who will benefit from TT are other priorities. Further data on (1) the overall long-term effects of TT, and (2) long-term effects on cardiovascular health and PCA risk are required, with particular emphasis on high-quality prospective/randomized clinical studies.
Mikkel Fode , Andrea Salonia , Suks Minhas , Arthur L. Burnett , Alan W. Shindel
Abstract
Men with low serum testosterone and symptoms of androgen deficiency may be diagnosed with testosterone deficiency. This condition is associated with metabolic syndrome and cardiovascular disease. The benefits (eg, improvement in sexual function) and risks (eg, prostate cancer and cardiovascular disease) of testosterone therapy are controversial. The American Urological Association and European Association of Urology guidelines on testosterone therapy differ on several points of management, likely reflecting the ambiguities surrounding testosterone therapy in practice. This paper summarizes both guidelines with a focus on the differences between the two sets of guidelines.
Patient summary
The benefits and risks of testosterone therapy are controversial, as reflected in the European Association of Urology and American Urological Association guidelines that differ on several points of management.
7. Goals for future research
Discrepancies between the guidelines reflect limited and conflicting evidence throughout the literature. Future studies should be designed with the intent of defining biochemical thresholds and elucidating the true clinical relevance of free T. Exploration of the effects of TT on overall QOL and identification of men with sexual dysfunction who will benefit from TT are other priorities. Further data on (1) the overall long-term effects of TT, and (2) long-term effects on cardiovascular health and PCA risk are required, with particular emphasis on high-quality prospective/randomized clinical studies.
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