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International Society for Sexual Medicine offers guidelines for treating testosterone deficiency
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The International Society for Sexual Medicine developed comprehensive guidelines to assist clinicians in better management and recognition of testosterone deficiency in men, according to research in The Journal of Sexual Medicine.
The International Society for Sexual Medicine (ISSM) convened a panel of 18 experts and developed the “Process of Care” to provide evidence-based recommendations for clinicians without expertise in endocrinology, the authors wrote, including physicians in family medicine and general urology practice. The guidelines outline who should be tested for testosterone deficiency, what drug interventions or lifestyle modifications are appropriate, and how the current controversy surrounding testosterone replacement therapy, prostate cancer and cardiovascular disease should be weighed.
The authors also noted that testosterone replacement therapy can result in impaired spermatogenesis and fertility, as well as reduced testicular volume, and recommended that men who wish to avoid those effects not be treated with testosterone.
John Dean
"The Process of Care characterizes testosterone deficiency and provides easy-to-follow, evidence-based guidance on its investigation and management, in both general and special populations, such as those with cardiovascular and prostate disease,” John Dean, MBBS, FRCGP, of the United Kingdom National Health Service, said in a press release. “It highlights the importance of identifying men with testosterone deficiency who want to maintain their fertility, which is likely to be compromised by testosterone replacement therapy, and who need a different approach to treatment.”
The Process of Care recommended testosterone deficiency be defined as a clinical and biochemical syndrome characterized by both a deficiency of testosterone or testosterone action, and relevant symptoms. The panel stressed that the condition may affect multiple organ systems as well as sexual function. The condition affects between 2% and 6% of men, and can often be linked with type 2 diabetes and obesity.
Addressing the possible links between testosterone therapy, prostate cancer and CVD, the researchers wrote that no long-term, large-scale, controlled studies support such concerns.
"Very importantly, [the Process of Care] should help doctors to make a consistent and reliable diagnosis of a much-neglected problem that may confer a significant health burden on the individual, and to identify the 'worried well' who may request testosterone replacement therapy but do not need it,” Dean said.
The researchers recommended that the Process of Care be re-evaluated and updated by the ISSM in 4 years. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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