Androgen Deficiency Syndromes

Selecting a Treatment Regimen ÎThe Endocrine Society recommends: > testosterone therapy for symptomatic men with classical androgen deficiency syndromes aimed at inducing and maintaining secondary sex characteristics and at improving their sexual function, sense of well-being, and bone mineral density. (1⎟ ⊕⊕) > against testosterone therapy in patients with breast (1⎟ ⊕) or prostate cancer; (1⎟ ⊕⊕) in patients with a palpable prostate nodule or induration, or PSA above 3 ng/mL without further urological evaluation; (1⎟ ⊕⊕) in patients with erythrocytosis, hyperviscosity, untreated obstructive sleep apnea, severe benign prostatic hyperplasia symptoms (AUA prostate symptom score > 19), or uncontrolled severe heart failure. (1⎟ ⊕) > against a general clinical policy of offering testosterone therapy to all older men with low testosterone levels. (1⎟ ⊕) ÎThe Endocrine Society suggests: > that clinicians offer testosterone therapy to men with low testosterone levels and low libido to improve libido (2⎟ ⊕⊕) and to men with erectile dysfunction (ED) who have unequivocally low testosterone levels after evaluation of underlying causes of ED and consideration of established therapies for ED. (2⎟ ⊕) > that clinicians consider offering testosterone therapy on an individualized basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency, after explicit discussion of the uncertainty about the risks and benefits of testosterone therapy. (2⎟ ⊕) > that clinicians consider short-term testosterone therapy as an adjunctive therapy in HIV- infected men with low testosterone levels and weight loss to promote weight maintenance and gains in lean body mass (LBM) and muscle strength. (2⎟ ⊕⊕) > that clinicians offer short-term testosterone therapy to men receiving high doses of glucocorticoids who have low testosterone levels to promote preservation of lean body mass (LBM) and bone mineral density. (2⎟ ⊕⊕) > that when clinicians prescribe testosterone therapy, the therapeutic target should be to raise serum testosterone levels into a range that is mid-normal for healthy young men. (2⎟ ⊕⊕) Table 4. Conditions in which testosterone administration is associated with a high risk of adverse outcome and for which the Endocrine Society recommends against using testosterone ÎVery high risk of serious adverse outcomes > Metastatic prostate cancer > Breast cancer ÎModerate to high risk of adverse outcomes > Unevaluated prostate nodule or induration > PSA > 4 ng/mL (> 3 ng/mL in individuals at high risk for prostate cancer, such as African Americans or men with first-degree relatives who have prostate cancer) > Hematocrit > 50% > Severe lower urinary tract symptoms associated with benign prostatic hypertrophy as indicated by AUA/IPSS score > 19* > Uncontrolled or poorly controlled congestive heart failure *AUA/IPSS = American Urological Association/International Prostate Symptom Score 3

• Cover
• Key Points
• Assessment and Diagnosis
• Selecting a Treatment Regimen
• Monitoring