Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations

Abstract

Key points and recommendations are:Excess cardiovascular events have been reported in some but not all studies of older men without pathological hypogonadism who were given testosterone treatment. Additional studies are needed to clarify whether testosterone therapy influences cardiovascular risk.Testosterone is the native hormone that should be replaced in men being treated for pathological hypogonadism. Convenient and cost-effective treatment modalities include depot intramuscular injection and transdermal administration (gel, cream or liquid formulations).Monitoring of testosterone therapy is recommended for efficacy and safety, focusing on ameliorating symptoms, restoring virilisation, avoiding polycythaemia and maintaining or improving bone mineral density.Treatment aims to relieve an individual's symptoms and signs of androgen deficiency by administering standard doses and maintaining circulating testosterone levels within the reference interval for eugonadal men.Evaluation for cardiovascular disease and prostate cancer risks should be undertaken as appropriate for eugonadal men of similar age. Nevertheless, when there is a reasonable possibility of substantive pre-existing prostate disease, digital rectal examination and prostate-specific antigen testing should be performed before commencing testosterone treatment.Changes in management as result of the position statement: Treatment aims to relieve symptoms and signs of androgen deficiency, using convenient and effective formulations of testosterone. Therapy should be monitored for efficacy and safety.

Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores

“…Conversely, the use of TTh as a supplementation for a lifestyle change must be avoided and discouraged. These results provide scientific evidence that directly contradicts the recommendation to limit the use of TTh only to men with classic hypogonadism [1]. Although the positive effects of TTh on hypogonadal men with ED were more apparent in lean subjects, it is possible that the positive effect of TTh on body composition [46][47][48] can eventually result in an improvement of ED even in hypogonadal obese patients, after longer-term therapy.…”

“…Administration that hypogonadism should only be treated in men with a limited list of underlying conditions, which has been called ''classic hypogonadism'' [1], nearly all studies included in this meta-analysis were comprised of populations of men without classic hypogonadism. For example, in the T trial [37] 63% of the participants were obese.…”

“…Recently, even the association between T deficiency and sexual symptoms has been questioned, because it has been speculated that it is derived from cross-sectional observations and it is conceivable that sexual inactivity drives a reduced testicular function, and not the other way around [1]. However, a longitudinal analysis of the European Male Aging Study cohort showed that the presence of sexual symptoms at baseline is not associated with an incipient high grade, whereas an incipient high grade at follow-up is associated with the development of sexual symptoms [7].…”

“…pdf) [1]. In the case of T deficiency (TD), there is uniform consensus among professional medical societies that the diagnosis requires a combination of symptoms/signs together with low serum T concentrations: a reduction of circulating T alone is not enough for diagnosing the condition [1][2][3].…”

Clinical practice update on testosterone therapy for male hypogonadism: Contrasting perspectives to optimize care

“…4 The Endocrine Society of Australia (ESA) published a Position Statement on the management of male hypogonadism, addressing assessment and indications for testosterone therapy 2 and treatment and therapeutic considerations. 5 The authors comprised eleven Australian endocrinologists with recognized clinical and/or research interests in this area, and updated a prior consensus guideline from ESA. 6 While there are clear areas of agreement between the ES and ESA recommendations, there are also substantive differences.…”