Critical Update of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism

Abstract

"Testosterone Therapy in Men With Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline" (Guidelines), published in 2010, serves as an important guide for the treatment of hypogonadal men. Using the Guidelines as a basis, we searched for the most recent level 1 evidence that continues to support the recommendations or provide an impetus to modify all or some of them. We performed a systematic analysis with a PubMed query from January 1, 2010, through March 2, 2015, using the following key words: testosterone/deficiency, testosterone/therapeutic use, cardiovascular, morbidity, mortality, screening, sexual function, lower urinary tract symptoms, obstructive sleep apnea, prostate cancer, fertility, bone mineral density, osteoporosis, quality of life, cognitive, erectile dysfunction, and adverse effects. We identified 17 trials representing level 1 evidence that specifically addressed recommendations made in the Guidelines. Trials examining outcomes of testosterone replacement therapy in men with severe lower urinary tract symptoms and untreated obstructive sleep apnea were identified, potentially refuting the current dogma against treatment in the setting of these conditions. Hypogonadal men with type 2 diabetes mellitus and metabolic syndrome were examined in several trials, demonstrating the beneficial effects of therapy on sexual function and insulin sensitivity. Several trials served as reinforcing evidence for the beneficial effects of testosterone therapy on osteoporosis, muscle strength, and symptoms of frailty. As in the Guidelines, inconsistent effects on quality of life, well-being, and erectile function were also noted in publications. Despite controversies surrounding cardiovascular morbidity and treatment in the setting of prostate cancer, no studies examining these issues as primary end points were identified. The low number of eligible studies since 2010 is a limitation of this analysis.

Clomiphene citrate treatment for late onset hypogonadism: rise and fall

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The Current Understanding of the Endocrine Effects From Immune Checkpoint Inhibitors and Recommendations for Management

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Associations Between Low Serum Testosterone and All-Cause Mortality and Infection-Related Hospitalization in Male Hemodialysis Patients: A Prospective Cohort Study

“… 8 , 9 Testosterone deficiency may also cause a decrease in bone mineral density, muscle mass, libido, and energy, and an increase in fat mass and insulin resistance. 10 Low serum testosterone has been reported as a risk factor for all-cause mortality and cardiovascular disease (CVD) events in the general population 11 , 12 and in hemodialysis patients. 4 , 5 , 6 , 7 However, previous studies that investigated the relationship between testosterone and mortality in dialysis patients had a relatively small sample size and enrolled participants from a single center.…”