Evaluation and Management of Testosterone Deficiency: AUA Guideline

Abstract

The care of testosterone deficient patients should focus on accurate assessment of total testosterone levels, symptoms, and signs as well as proper on-treatment monitoring to ensure therapeutic testosterone levels are reached and symptoms are ameliorated. Future longitudinal observational studies and clinical trials of significant duration in this space will improve diagnostic techniques and treatment of men with testosterone deficiency as well as provide more data on the adverse events that may be associated with testosterone therapy.

Guideline of guidelines: testosterone therapy for testosterone deficiency

“…injections and s.c. pellets. The AUA, AACE, BSSM, and ISSM recommend against oral 17α alkylated testosterone because it can lead to hepatotoxicity . The AUA, EAU, BSSM, and AACE all recognise the risk of transference with topical TTh (Table ) .…”

“…However, there is concern in the literature that TTh can increase risk of major adverse cardiovascular events (MACE), such as MI or cerebrovascular accident. All guideline committees either comment that there is insufficient data in the literature that TTh increases the risk of MACE, or acknowledge the conflicting data (Table ) . Per the AUA guidelines, TTh should not be given to patients who have had a MI or stroke within the past 3–6 months .…”

“…All guideline committees either comment that there is insufficient data in the literature that TTh increases the risk of MACE, or acknowledge the conflicting data (Table ) . Per the AUA guidelines, TTh should not be given to patients who have had a MI or stroke within the past 3–6 months . The AACE and Endocrine Society list an MI or cerebrovascular accident in the past 6 months as a relative contraindication to TTh .…”

“…Low testosterone is thought to be a risk factor for cardiovascular disease with more major cardiovascular events, such as myocardial infarction (MI) or stroke, in men with TD. However, there is concern in the literature that TTh can Noted concern Noted concern Noted concern Noted concern NR Polycythaemia on TTh (Table 4) [1,2,[4][5][6][7][8]. Per the AUA guidelines, TTh should not be given to patients who have had a MI or stroke within the past 3-6 months [1].…”

Klinefelter syndrome: From pediatrics to geriatrics

“…One reason for this increased risk is that the viscosity of blood in KS patients is high, causing the formation of venous thromboembolism . In addition, Campbell et al found that the risks of pulmonary embolism and deep venous thrombosis were 5‐20 times higher in KS patients than in normal healthy men . The updated AUA guideline for the evaluation and management of testosterone deficiency indicates that whether TRT increases or decreases the risk of cardiovascular events cannot be definitively stated.…”