An expert panel convened by the International Society for Sexual Medicine has developed a detailed "Process of Care" for the diagnosis and management of testosterone deficiency in men.
After an extensive literature review and in-depth consultations, the panel of 18 experts from a wide range of medical disciplines recommended that testosterone deficiency be defined as a clinical and biochemical syndrome characterized by both a deficiency of testosterone or testosterone action, and relevant symptoms. The panel stressed that the condition may affect multiple organ systems as well as sexual function. They also noted that the prevalence of symptomatic testosterone deficiency in men is within the range of 2% to 6%, and it is often associated with obesity and type 2 diabetes, but not necessarily with aging.
The Process of Care provides information on who should be tested for testosterone deficiency, which tests to perform, and which lifestyle modifications or drug interventions are appropriate for different types of patients. It also provides recommendations on when and how to monitor patients after initiating treatment.
The expert panel noted that decisions regarding the appropriate use of testosterone replacement therapy have been complicated by well-publicized controversies about a possible relationship between testosterone replacement therapy and risk of developing prostate cancer and heart disease. The panel found that there were no large-scale, long-term, controlled studies that supported such concerns and that the balance of available evidence is strongly against there being any such relationship in men who are appropriately treated.
"The Process of Care characterizes testosterone deficiency and provides easy-to-follow, evidence-based guidance on its investigation and management, in both general and special populations, such as those with cardiovascular and prostate disease. It highlights the importance of identifying men with testosterone deficiency who want to maintain their fertility, which is likely to be compromised by testosterone replacement therapy, and who need a different approach to treatment," said Dr. John Dean, lead author of the Process of Care, which is published in The Journal of Sexual Medicine. "Very importantly, it should help doctors to make a consistent and reliable diagnosis of a much-neglected problem that may confer a significant health burden on the individual, and to identify the 'worried well' who may request testosterone replacement therapy but do not need it."