How do medical professionals make decisions when diagnosing and treating a disease? Certainly their continuing medical education helps, and most continue to attend conferences and conduct research in peer-reviewed journals in their field.
However, experts also refer to guidelines published by medical societies such as the International Society of Sexual Medicine (ISSM) or the American Urological Association (AUA). Society panels scrutinize the latest clinical trials and other research and use that evidence to develop recommendations.
For the past few years, testosterone replacement therapy has been a hot topic in the medical community. Last August, we covered new guidelines from the American Urological Association. Today we'll discuss a set of updated guidelines from the Endocrine Society, an expert group of more than 18,000 hormone experts.
Because testosterone is an important hormone for men, this list of guidelines can be an essential tool for sexual health professionals and primary care physicians treating men with hypogonadism (low testosterone).
The Endocrine Society guidelines were originally published in 2010 and updated in 2018.
(Note: For a primer on hypogonadism, see the link at the bottom of this post.)
Why was the guidance updated?
Scientists have conducted a lot of research on testosterone therapy in recent years. The updated guidance reflects new findings and addresses concerns.
Additionally, more and more men are seeking help for problems related to testosterone deficiency these days, and “low t” gets a lot of media coverage. As a result, men are asking their doctors if testosterone therapy could help them. It is important that prescribers fully understand the benefits and risks.
What does the updated guidance say?
Highlights of the Endocrine Society's updated guidelines for hypogonadism include:
Diagnosis
- In general, men should not undergo routine testing for hypogonadism. However, if a man has symptoms (such as low libido or fatigue) and blood tests show lower-than-normal testosterone levels, a diagnosis of hypogonadism is recommended.
- Based on other hormonal measurements, men can be diagnosed with the following disorders: Primary hypogonadism (caused by problems with the testicles) or Secondary hypogonadism (Caused by problems in the part of the brain that causes testosterone production)
therapy
- The recommended goals of testosterone therapy are to “induce and maintain” testosterone-induced secondary sexual characteristics (facial hair, muscle mass, etc.) and relieve symptoms such as low libido.
- Testosterone treatment is not recommended for men who want to father children in the near future. Men with certain health problems (such as prostate cancer, breast cancer, severe untreated obstructive sleep apnea, recent heart attack or stroke) should not take testosterone.
- Testosterone treatment may not be appropriate for men between the ages of 55 and 69 who are expected to live another 10 years or more. Physicians should discuss the benefits and risks with these patients.
- Men over the age of 65 should not be regularly prescribed testosterone. Instead, doctors must consider each individual's situation.
- Men who have HIV, low testosterone, and have lost weight may receive testosterone therapy to gain and maintain weight.
- Men with diabetes and low testosterone levels should not use testosterone as a way to control blood sugar.
monitoring
- Once testosterone treatment begins, men should undergo regular check-ups to ensure that the treatment is working well and that there are no side effects.
- Men with abnormal prostate cancer test results during the first year of treatment should see a urologist.
What does this mean for patients?
These guidelines are intended for medical professionals, but may also be useful for men.
Understanding the instructions for any treatment you receive will help you weigh the pros and cons of treatment when making health decisions.
“that much [updated Endocrine Society] “The guidelines emphasize the importance of patient participation in the shared decision-making process, particularly with regard to treatment regimen selection and prostate monitoring,” Dr. Shalender Bhasin, head of the guideline development task force, said in an interview with Endocrine News.
Learn more
For more information about hypogonadism and testosterone, see the following links:
low testosterone
Unpacking the Latest Testosterone Treatment Guidelines
What should men know about topical testosterone?
Launch of self-injectable testosterone
FDA approves testosterone in pill form
resource
endocrine news
“Q&A: Shalender Bhasin, MD”
(May 2018)
Endocrine Society
“About the Endocrine Society”
https://www.endocrine.org/about-us
“Testosterone treatment guideline material for hypogonadism”
https://www.endocrine.org/guidelines-and-clinical-practice/clinical-practice-guidelines/testosterone-therapy
Journal of Clinical Endocrinology and Metabolism
Bhasin, Shalender, etc.
“Testosterone Treatment in Men with Hypogonadism: Endocrine Society Clinical Practice Guidelines”
(Full text. Posted: March 17, 2018)
https://academic.oup.com/jcem/article/103/5/1715/4939465