Endocrine Society Updates Testosterone Therapy Guidelines
The Endocrine Society has recommended against prescribing testosterone therapy to men aged ≥65 years with low testosterone levels, as the risks and benefits of testosterone therapy are unclear. The recommendation is part of the new "Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline," published in The Journal of Clinical Endocrinology & Metabolism, an update to the Society's previous guideline in 2010.
The latest recommendations are based on new scientific evidence from large randomized trials and recent improvements in testosterone measures. "Some men receiving testosterone therapy do not have adequately documented hypogonadism, while others who have hypogonadism are not receiving the needed treatment," said Shalender Bhasin, MD, of Brigham and Women's Hospital, Massachusetts, and chair of the task force who authored the guideline.
According to the new guideline, men should only be diagnosed with hypogonadism if they have symptoms of a testosterone deficiency and their total or free testosterone levels are "unequivocally and consistently low." The authors acknowledged how an individual's testosterone levels can fluctuate greatly over time, making it vital to confirm measurements. The authors say that ~30% of men who have testosterone measurements in the hypogonadal range will display normal concentrations when retested.
As an initial diagnostic test, the Society recommends measuring fasting morning total testosterone and confirming the diagnosis via repeat measurement of morning fasting total testosterone. For ideal testing, the Society states that an assay certified by the Centers for Disease Control and Prevention (CDC) or one verified by an external quality control program should be used by clinicians to measure testosterone levels.
When incorporating testosterone therapy, clinicians should aim for testosterone concentrations in the mid-normal range during treatment. Monitoring should include a standardized plan of evaluating symptoms, adverse effects, serum testosterone and hematocrit, and evaluating prostate cancer risk during the first year of therapy.
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