The American Urological Association (AUA) is the professional organization for urologists. Founded in 1902, the organization currently has more than 21,000 members. One of their many roles is to provide guidance on various aspects of urological health so that doctors can best serve their patients.
In April 2018, the AUA published new clinical guidelines for the diagnosis and treatment of testosterone deficiency. It contains 31 recommendations. Today we'll unpack some of the highlights here.
What is Testosterone Deficiency?
You've probably heard of testosterone in terms of male sexual health. Produced in the testes, this hormone stimulates sexual desire, gives men physical characteristics (such as facial hair), and helps maintain muscle mass.
Some men do not have enough testosterone in their bodies. This condition, called hypogonadism, can occur when there is a problem with the testes or the part of the brain that causes testosterone production. Hypogonadism may also be the result of chemotherapy, radiation therapy, inflammation, infection, and obesity. (Learn more about the causes of low testosterone here.)
Additionally, men's bodies produce less testosterone as they age. In fact, after age 40 in men, testosterone levels decline by 1% to 3% per year.Day birthday. As a result, some, but not all, men begin to experience symptoms such as low libido, fatigue, depression, erectile dysfunction (ED), and loss of muscle mass.
How is testosterone deficiency diagnosed?
According to the new AUA guidelines, two criteria must be present for a man to be diagnosed with testosterone deficiency.
- His testosterone level must be less than 300 ng/dL. It is recommended to measure total testosterone twice on two separate occasions. Testosterone levels in men fluctuate throughout the day, so early morning measurements are common.
- Men should exhibit the same low testosterone symptoms mentioned above (low sex drive, low energy, depression, erectile dysfunction, etc.).
If a man meets just one of these criteria, he is not testosterone deficient.
What is Testosterone Replacement Therapy (TRT)?
Testosterone replacement therapy (TRT) is prescribed for some men with testosterone deficiency. This synthetic form of testosterone is usually administered via gel, patch, or injection.
What does AUA recommend?
Some of the recommendations made by AUA include:
- Clinicians should inform patients with testosterone deficiency that low testosterone is a risk factor for cardiovascular disease. Note: In 2015, the U.S. Food and Drug Administration (FDA) issued an advisory expressing concern that men taking testosterone may have a higher risk of heart attack and stroke. (See more details here.) However, links to these events were considered controversial.
- Clinicians should inform patients that there is no evidence linking testosterone therapy and the development of prostate cancer. Note: There have been concerns that testosterone treatment may lead to prostate cancer, but this link has not been proven. However, TRT is not generally recommended for men with prostate cancer because testosterone can stimulate the growth of existing prostate cancer cells.
- The long-term effects of exogenous testosterone on spermatogenesis should be discussed with patients concerned about future fertility. Exogenous testosterone therapy should not be prescribed to men currently trying to become pregnant. Note: Testosterone is important for sperm production, but the synthetic form used in TRT may interfere with this process. Sometimes sperm counts increase after a man stops TRT, but this cannot be guaranteed. Men may decide to store their sperm before starting treatment.
- Clinicians should discuss the risk of metastasis with patients using testosterone gel/cream. It is recommended that men wash their hands thoroughly after applying testosterone to their skin to avoid spreading it to others. You should also cover the application area before sexual intercourse. (For example, if you are applying testosterone to your shoulder, wearing a t-shirt can reduce the risk of passing the gel or cream to your partner.)
- While receiving testosterone treatment, testosterone levels should be measured every 6 to 12 months. Note: While receiving TRT, it is important for men to see their doctor regularly for follow-up appointments so that their testosterone levels can be evaluated and treatment adjusted if necessary.
Is TRT Right for You?
As noted above, the discussion here covers only some of the AUA recommendations. The guidelines themselves, along with a complete evaluation of your overall health, can help you and your doctor decide whether TRT is right for you.
resource
American Urological Association
“AUA Announces New Clinical Guidelines for Diagnosis and Treatment of Testosterone Deficiency”
(Press release. April 10, 2018)
http://auanet.mediaroom.com/2018-04-10-AUA-Releases-New-Clinical-Guideline-For-Diagnosis-And-Treatment-Of-Testosterone-Deficiency
“Assessment and Management of Testosterone Deficiency”
(published in 2018)
http://www.auanet.org/guidelines/testosterone-deficiency-(2018)#x7647
International Society of Sexual Medicine
“Can testosterone replacement therapy (TRT) make men infertile?”
http://www.issm.info/sexual-health-qa/can-testosterone-replacement-therapy-trt-make-a-man-infertile/
“What are the side effects and risks of testosterone treatment?”
http://www.issm.info/ sexual-health-qa/what-are-some-of-the-side-effects-and-risks-of-testosterone-therapy/
MPR
“AUA: New Guidelines for Diagnosis and Management of Testosterone Deficiency”
(April 10, 2018)
https://www.empr.com/aua-new-guidelines-for-diagnosis-management-of-testosterone-deficiency/printarticle/757348/
SexHealthMatters.org
“What Causes Low Testosterone?”
(November 2, 2015)
https://www.sexhealthmatters.org/sex-health-blog/what-causes-low-testosterone