Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE)

Abstract

Purpose To provide the evidence-based recommendations on the role of testosterone (T) on age-related symptoms and signs remains. Methods The Italian Society of Andrology and Sexual Medicine (SIAMS) and the and the Italian Society of Endocrinology (SIE) commissioned an expert task force to provide an updated guideline on adult-onset male hypogonadism. Derived recommendations were based on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results Clinical diagnosis of adult-onset hypogonadism should be based on a combination of clinical and biochemical parameters. Testosterone replacement therapy (TRT) should be offered to all symptomatic subjects with hypogonadism after the exclusion of possible contraindications. T gels and the long-acting injectable T are currently available preparations showing the best efficacy/safety profile. TRT can improve all aspects of sexual function, although its effect is limited in more complicated patients. Body composition (reducing fat mass and increasing lean mass) is improved after TRT, either in subjects with or without metabolic syndrome or type 2 diabetes. Conversely, the role of TRT in improving glycometabolic control is more conflicting. TRT can result in increasing bone mineral density, particularly at lumbar site, but no information on fracture risk is available. Limited data support the use of TRT for improving other outcomes, including mood frailty and mobility. Conclusions TRT can improve sexual function and body composition particularly in less complicated adult and in aging subjects with hypogonadism. When hypogonadism is adequately diagnosed, T appropriately prescribed and subjects correctly followed up, no short-term increased risk of adverse events is observed. Longer and larger studies are advisable to better clarify TRT long-term efficacy/safety profile.

Sexual and Reproductive Outcomes in Obese Fertile Men with Functional Hypogonadism after Treatment with Liraglutide: Preliminary Results

“…A total of 110 men aged 18 to 35 years (mean age: 26 ± 6) were consecutively enrolled, after signing informed consent, according to the following inclusion criteria: Moderate and/or severe obesity (body mass index (BMI) of between 30 and 39.99); Waist circumference >94 cm; Severe erectile dysfunction ((ED)—International Index of Erectile Function 5 Items (IIEF-5) score below 7) that is unresponsive to conventional treatment with PDE5i during the last 3 months, according to a previously published procedure [ 10 ]; TT < 12 nmol/L according to the Italian Society of Endocrinology guidelines [ 11 ]; Normal–low gonadotropin levels (lowest quartiles of the reference range); Levels of sex hormone-binding globulin (SHBG) that are reduced compared to the reference range (confirmed data); Homeostasis Model Assessment Index (HOMA) > 2.5 [ 12 ]. …”

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

“…Hence, T levels should be checked in all subjects with ED. Calculated free T (cfT) has been suggested as a better marker of androgenization in patients with ED, considering that sex hormone binding globulin (SHBG) can profoundly influence total T levels in some clinical conditions, particularly in the presence of metabolic diseases [ 194 ]. Hence, the determination of SHBG is strongly suggested in all subjects in order to cfT.…”

“…Hence, the determination of SHBG is strongly suggested in all subjects in order to cfT. Total T < 12 nmo/L and fT < 220 pmol/L should be considered as a cut-off for defining hypogonadism [ 194 ]. In addition, the concomitant determination of luteinizing hormone (LH) and follicular stimulating hormone (FSH) can help to define the specific nature of the issue (primary or secondary hypogonadism).…”

“…In addition, the concomitant determination of luteinizing hormone (LH) and follicular stimulating hormone (FSH) can help to define the specific nature of the issue (primary or secondary hypogonadism). Specific diagnostic work-up and indications for management of hypogonadism have been reported elsewhere [ 194 ]…”

Testosterone Therapy in Men with Klinefelter Syndrome: Analysis of a Global Federated Research Network

“… 8 Testosterone replacement therapy (TRT) in men with KS should secure development of sexual male characteristics and prevent long-term sequelae of chronic hypogonadism. 9 …”