| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
CLINICAL PRACTICE GUIDELINE |
Boston University School of Medicine (S.B.), Boston, Massachusetts 02118; Baylor College of Medicine/Veterans Affairs Medical Center (G.R.C.), Houston, Texas 77030; Massachusetts General Hospital/Harvard Medical School (F.J.H.), Boston, Massachusetts 02114; University of Washington/Veterans Affairs Puget Sound Health Care System (A.M.M.), Seattle, Washington 98108; University of Pennsylvania School of Medicine (P.J.S.), Philadelphia, Pennsylvania 19104; Harbor University of California, Los Angeles Medical Center (R.S.S.), Torrance, California 90502; and Mayo Clinic (V.M.M.), Rochester, Minnesota 55905
Address all questions to: The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, MD 20815. E-mail: govt-prof{at}endo-society.org. Telephone: 301-941-0200. Address all reprint requests for orders 101 and more to: Heather Edwards, Reprint Sales Specialist, Cadmus Professional Communications, Telephone: 410-691-6214, Fax: 410-684-2789 or by E-mail: endoreprints{at}cadmus.com. Address all reprint requests for orders 100 or less to Society Services, Telephone: 301-941-0210 or by E-mail: societyservices{at}endo-society.org.
Objective: The objective was to provide guidelines for the evaluation and treatment of androgen deficiency syndromes in adult men.
Participants: The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, five additional experts, a methodologist, and a professional writer. The Task Force received no corporate funding or remuneration.
Evidence: The Task Force used systematic reviews of available evidence to inform its key recommendations. The Task Force used consistent language and graphical descriptions of both the strength of recommendation and the quality of evidence, using the recommendations of the Grading of Recommendations, Assessment, Development, and Evaluation group.
Consensus Process: Consensus was guided by systematic reviews of evidence and discussions during three group meetings, several conference calls, and e-mail communications. The drafts prepared by the panelists with the help of a professional writer were reviewed successively by The Endocrine Society’s Clinical Guidelines Subcommittee, Clinical Affairs Committee, and Council. The version approved by the Council was placed on The Endocrine Society’s web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes.
Conclusions: We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels. We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test. We recommend confirmation of the diagnosis by repeating the measurement of morning total testosterone and in some patients by measurement of free or bioavailable testosterone level, using accurate assays. We recommend testosterone therapy for symptomatic men with androgen deficiency, who have low testosterone levels, to induce and maintain secondary sex characteristics and to improve their sexual function, sense of well-being, muscle mass and strength, and bone mineral density. We recommend against starting testosterone therapy in patients with breast or prostate cancer, a palpable prostate nodule or induration or prostate-specific antigen greater than 3 ng/ml without further urological evaluation, erythrocytosis (hematocrit > 50%), hyperviscosity, untreated obstructive sleep apnea, severe lower urinary tract symptoms with International Prostate Symptom Score (IPSS) greater than 19, or class III or IV heart failure. When testosterone therapy is instituted, we suggest aiming at achieving testosterone levels during treatment in the mid-normal range with any of the approved formulations, chosen on the basis of the patient’s preference, consideration of pharmacokinetics, treatment burden, and cost. Men receiving testosterone therapy should be monitored using a standardized plan.
This article has been cited by other articles:
 |
|
 |
|
  R. S. Ribeiro and J. Abucham Recovery of persistent hypogonadism by clomiphene in males with prolactinomas under dopamine agonist treatment Eur. J. Endocrinol., July 1, 2009; 161(1): 163 - 169. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Theodoraki and P.-M. Bouloux Testosterone therapy in men Menopause Int, June 1, 2009; 15(2): 87 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. R. Sattler, C. Castaneda-Sceppa, E. F. Binder, E. T. Schroeder, Y. Wang, S. Bhasin, M. Kawakubo, Y. Stewart, K. E. Yarasheski, J. Ulloor, et al. Testosterone and Growth Hormone Improve Body Composition and Muscle Performance in Older Men J. Clin. Endocrinol. Metab., June 1, 2009; 94(6): 1991 - 2001. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-J. Legros, E. J H Meuleman, J. M H Elbers, T B P. Geurts, M. J G H Kaspers, P. M G Bouloux, and for the Study 43203 Investigators Oral testosterone replacement in symptomatic late-onset hypogonadism: effects on rating scales and general safety in a randomized, placebo-controlled study Eur. J. Endocrinol., May 1, 2009; 160(5): 821 - 831. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Sacca Heart Failure as a Multiple Hormonal Deficiency Syndrome Circ Heart Fail, March 1, 2009; 2(2): 151 - 156. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Sartorius, L. P Ly, K. Sikaris, R. McLachlan, and D. J Handelsman Predictive accuracy and sources of variability in calculated free testosterone estimates Ann Clin Biochem, March 1, 2009; 46(2): 137 - 143. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Hall, A. B. Araujo, T. G. Travison, G. R. Esche, J. B. McKinlay, R. V. Clark, and R. E. Williams Men, Androgen Deficiency, and Pharmaceutical Promotion--Reply Arch Intern Med, January 12, 2009; 169(1): 88 - 89. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Wang, E. Nieschlag, R. Swerdloff, H. M. Behre, W. J. Hellstrom, L. J. Gooren, J. M. Kaufman, J.-J. Legros, B. Lunenfeld, A. Morales, et al. Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and ASA Recommendations J Androl, January 1, 2009; 30(1): 1 - 9. [Full Text] [PDF]
|
|
|
|
|
|
C Wang, E Nieschlag, R Swerdloff, H M Behre, W J Hellstrom, L J Gooren, J M Kaufman, J-J Legros, B Lunenfeld, A Morales, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations Eur. J. Endocrinol., November 1, 2008; 159(5): 507 - 514. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Rice, R. E. Brannigan, R. K. Campbell, S. Fine, L. Jack Jr, J. B. Nelson, and J. Regan-Klich Men's Health, Low Testosterone, and Diabetes: Individualized Treatment and a Multidisciplinary Approach The Diabetes Educator, November 1, 2008; 34(5_suppl): 97S - 112S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hall, G. R. Esche, A. B. Araujo, T. G. Travison, R. V. Clark, R. E. Williams, and J. B. McKinlay Correlates of Low Testosterone and Symptomatic Androgen Deficiency in a Population-Based Sample J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3870 - 3877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Farrell, A. Deshmukh, and A. A. Baghaie Low Testosterone and the Association With Type 2 Diabetes The Diabetes Educator, September 1, 2008; 34(5): 799 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Simon Testosterone deficiency--the male menopause? InnovAiT, September 1, 2008; 1(9): 625 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. C. W. Wu, A. Tajar, S. R. Pye, A. J. Silman, J. D. Finn, T. W. O'Neill, G. Bartfai, F. Casanueva, G. Forti, A. Giwercman, et al. Hypothalamic-Pituitary-Testicular Axis Disruptions in Older Men Are Differentially Linked to Age and Modifiable Risk Factors: The European Male Aging Study J. Clin. Endocrinol. Metab., July 1, 2008; 93(7): 2737 - 2745. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Platz Low Testosterone and Risk of Premature Death in Older Men: Analytical and Preanalytical Issues in Measuring Circulating Testosterone Clin. Chem., July 1, 2008; 54(7): 1110 - 1112. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Khosla, S. Amin, and E. Orwoll Osteoporosis in Men Endocr. Rev., June 1, 2008; 29(4): 441 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. B. Araujo, T. G. Travison, B. Z. Leder, and J. B. McKinlay Correlations between Serum Testosterone, Estradiol, and Sex Hormone-Binding Globulin and Bone Mineral Density in a Diverse Sample of Men J. Clin. Endocrinol. Metab., June 1, 2008; 93(6): 2135 - 2141. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. E. Knapp, T. W. Storer, K. L. Herbst, A. B. Singh, C. Dzekov, J. Dzekov, M. LaValley, A. Zhang, J. Ulloor, and S. Bhasin Effects of a supraphysiological dose of testosterone on physical function, muscle performance, mood, and fatigue in men with HIV-associated weight loss Am J Physiol Endocrinol Metab, June 1, 2008; 294(6): E1135 - E1143. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hall, A. B. Araujo, G. R. Esche, R. E. Williams, R. V. Clark, T. G. Travison, and J. B. McKinlay Treatment of Symptomatic Androgen Deficiency: Results From the Boston Area Community Health Survey Arch Intern Med, May 26, 2008; 168(10): 1070 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Loves, J. Ruinemans-Koerts, and H. de Boer Letrozole once a week normalizes serum testosterone in obesity-related male hypogonadism Eur. J. Endocrinol., May 1, 2008; 158(5): 741 - 747. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Page and A. M. Matsumoto Effects of Testosterone Therapy in Older Men JAMA, April 23, 2008; 299(16): 1900 - 1900. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Wald, M. Miner, and A. D. Seftel State of the Art Reviews: Male Menopause: Fact or Fiction? American Journal of Lifestyle Medicine, April 1, 2008; 2(2): 132 - 141. [Abstract] [PDF]
|
|
|
|
|
|
A. D. Coviello, B. Kaplan, K. M. Lakshman, T. Chen, A. B. Singh, and S. Bhasin Effects of Graded Doses of Testosterone on Erythropoiesis in Healthy Young and Older Men J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 914 - 919. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Swiglo, M. H. Murad, H. J. Schunemann, R. Kunz, R. A. Vigersky, G. H. Guyatt, and V. M. Montori A Case for Clarity, Consistency, and Helpfulness: State-of-the-Art Clinical Practice Guidelines in Endocrinology Using the Grading of Recommendations, Assessment, Development, and Evaluation System J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 666 - 673. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Swerdloff and C. Wang Free Testosterone Measurement by the Analog Displacement Direct Assay: Old Concerns and New Evidence Clin. Chem., March 1, 2008; 54(3): 458 - 460. [Full Text] [PDF]
|
|
|
|
|
|
G. A. Laughlin, E. Barrett-Connor, and J. Bergstrom Low Serum Testosterone and Mortality in Older Men J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 68 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Allan, B. J. G. Strauss, H. G. Burger, E. A. Forbes, and R. I. McLachlan Testosterone Therapy Prevents Gain in Visceral Adipose Tissue and Loss of Skeletal Muscle in Nonobese Aging Men J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 139 - 146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. T. McVary Erectile Dysfunction N. Engl. J. Med., December 13, 2007; 357(24): 2472 - 2481. [Full Text] [PDF]
|
|
|
|
|
|
C. Schulman The Effect of Obesity on Disability vs Mortality in Older American: The Potential Implication of Testosterone Arch Intern Med, December 10, 2007; 167(22): 2528 - 2528. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Handelsman Update in Andrology J. Clin. Endocrinol. Metab., December 1, 2007; 92(12): 4505 - 4511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Braunstein The Endocrine Society Clinical Practice Guideline and The North American Menopause Society Position Statement on Androgen Therapy in Women: Another One of Yogi's Forks J. Clin. Endocrinol. Metab., November 1, 2007; 92(11): 4091 - 4093. [Full Text] [PDF]
|
|
|
|
|
|
A. B. Araujo, G. R. Esche, V. Kupelian, A. B. O'Donnell, T. G. Travison, R. E. Williams, R. V. Clark, and J. B. McKinlay Prevalence of Symptomatic Androgen Deficiency in Men J. Clin. Endocrinol. Metab., November 1, 2007; 92(11): 4241 - 4247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Zitzmann and E. Nieschlag Androgen Receptor Gene CAG Repeat Length and Body Mass Index Modulate the Safety of Long-Term Intramuscular Testosterone Undecanoate Therapy in Hypogonadal Men J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3844 - 3853. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Hammond, J. R. Abrams, and K. L. Syrjala Fertility and Risk Factors for Elevated Infertility Concern in 10-Year Hematopoietic Cell Transplant Survivors and Case-Matched Controls J. Clin. Oncol., August 10, 2007; 25(23): 3511 - 3517. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Hall, S. T. Page, T. G. Travison, R. B. Montgomery, C. L. Link, and J. B. McKinlay Do Statins Affect Androgen Levels in Men? Results from the Boston Area Community Health Survey Cancer Epidemiol. Biomarkers Prev., August 1, 2007; 16(8): 1587 - 1594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. L. Nielsen, C. Hagen, K. Wraae, K. Brixen, P. H. Petersen, E. Haug, R. Larsen, and M. Andersen Visceral and Subcutaneous Adipose Tissue Assessed by Magnetic Resonance Imaging in Relation to Circulating Androgens, Sex Hormone-Binding Globulin, and Luteinizing Hormone in Young Men J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2696 - 2705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. B Yeap, O. P Almeida, Z. Hyde, P. E Norman, S A P. Chubb, K. Jamrozik, and L. Flicker In men older than 70 years, total testosterone remains stable while free testosterone declines with age. The Health in Men Study Eur. J. Endocrinol., May 1, 2007; 156(5): 585 - 594. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Kapoor, H. Aldred, S. Clark, K. S. Channer, and T. H. Jones Clinical and Biochemical Assessment of Hypogonadism in Men With Type 2 Diabetes: Correlations with bioavailable testosterone and visceral adiposity Diabetes Care, April 1, 2007; 30(4): 911 - 917. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bhasin, R. A. Parker, F. Sattler, R. Haubrich, B. Alston, T. Umbleja, C. M. Shikuma, and for the AIDS Clinical Trials Group Protocol A5079 Effects of Testosterone Supplementation on Whole Body and Regional Fat Mass and Distribution in Human Immunodeficiency Virus-Infected Men with Abdominal Obesity J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 1049 - 1057. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. T. Page, A. M. Matsumoto, W. J. Bremner, M. Yasuda, S. Horie, T. T. Perls, N. Gleicher, D. Barad, K. S. Nair, and G. Smith DHEA and Testosterone in the Elderly N. Engl. J. Med., February 8, 2007; 356(6): 635 - 637. [Full Text] [PDF]
|
|
|
|
|
|
D. Shames, A. Gassman, and H. Handelsman Guideline for Male Testosterone Therapy: A Regulatory Perspective J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 414 - 415. [Full Text] [PDF]
|
|
|
|
|
|
A. Morgentaler Guideline for Male Testosterone Therapy: A Clinician's Perspective J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 416 - 417. [Full Text] [PDF]
|
|
|
|
|
|
F. C. W. Wu Guideline for Male Testosterone Therapy: A European Perspective J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 418 - 419. [Full Text] [PDF]
|
|
|
|
 |
|
 E. R. Bolona, M. V. Uraga, R. M. Haddad, M. J. Tracz, K. Sideras, C. C. Kennedy, S. M. Caples, P. J. Erwin, and V. M. Montori Testosterone Use in Men With Sexual Dysfunction: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials Mayo Clin. Proc., January 1, 2007; 82(1): 20 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Haddad, C. C. Kennedy, S. M. Caples, M. J. Tracz, E. R. Bolona, K. Sideras, M. V. Uraga, P. J. Erwin, and V. M. Montori Testosterone and Cardiovascular Risk in Men: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials Mayo Clin. Proc., January 1, 2007; 82(1): 29 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. H. Lewis, M. Legato, and H. Fisch Medical Implications of the Male Biological Clock. JAMA, November 15, 2006; 296(19): 2369 - 2371. [Full Text] [PDF]
|
|
|
|
 |
|
 Practice Guideline: Androgen Deficiency in Adult Men Journal Watch (General), July 13, 2006; 2006(713): 5 - 5. [Full Text]
|
|
Read all eLetters
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Endocrinology | Endocrine Reviews | J. Clin. End. & Metab. |
| Molecular Endocrinology | Recent Prog. Horm. Res. | All Endocrine Journals |
