Treatment
8
Treatment of Hypogonadism with Testosterone
➤ ES recommends testosterone therapy in hypogonadal men to induce
and maintain secondary sex characteristics and correct symptoms of
testosterone deficiency. (1|⊕⊕⊕
)
➤ ES recommends against testosterone therapy in men planning
fertility in the near term or in men with breast or prostate cancer, a
palpable prostate nodule or induration, a prostate-specific antigen
level >4 ng/mL, a prostate-specific antigen level >3 ng/mL combined
with a high risk of prostate cancer (without further urological
evaluation), elevated hematocrit, untreated severe obstructive sleep
apnea, severe lower urinary tract symptoms, uncontrolled heart
failure, myocardial infarction or stroke within the last 6 months, or
thrombophilia. (1|⊕⊕
)
➤ In hypogonadal men 55–69 years old, who are being considered
for testosterone therapy and have a life expectancy >10 years, ES
suggests discussing the potential benefits and risks of evaluating
prostate cancer risk and prostate monitoring and engaging the patient
in shared decision making regarding prostate cancer monitoring. For
patients who choose monitoring, clinicians should assess prostate
cancer risk before starting testosterone treatment and 3–12 months
after starting testosterone (2|⊕
). In hypogonadal men being
considered for testosterone therapy who are 40–69 years old and
at increased risk of prostate cancer (e.g., African Americans and
men with a first-degree relative with diagnosed prostate cancer), ES
suggests discussing prostate cancer risk with the patient and offering
monitoring options. (2|⊕
)
Older Men with Age-Related Decline in Testosterone Concentration
➤ ES suggests against routinely prescribing testosterone therapy
to all men 65 years or older with low testosterone concentrations
(1|⊕⊕
). In men >65 years who have symptoms or conditions
suggestive of testosterone deficiency (such as low libido or
unexplained anemia) and consistently and unequivocally low
morning testosterone concentrations, ES suggests that clinicians
offer testosterone therapy on an individualized basis after explicit
discussion of the potential risks and benefits. (2|⊕⊕
)
