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Article: Shalender Bhasin, Glenn R. Cunningham, Frances J. Hayes, Alvin M. Matsumoto, Peter J. Snyder, Ronald S. Swerdloff, and Victor M. Montori Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab 2006; 0: jc.2005-2847v1 [Abstract]

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Selecting the Correct Terminology for Testosterone Deficiency

Alvaro Morales, Claude Schulman, Jacques Tostain, and Frederick C.W. Wu   (15 June 2006)

Selecting the Correct Terminology for Testosterone Deficiency 15 June 2006
Alvaro Morales, Professor of Urology Queen's University, Claude Schulman, Jacques Tostain, and Frederick C.W. Wu Send letter to journal: Re: Selecting the Correct Terminology for Testosterone Deficiency moralesa{at}post.queensu.ca Alvaro Morales, et al.	The Endocrine Society Clinical Practice Guidelines for testosterone therapy in adult men with androgen deficiency (1) is a well thought out, timely and welcomed document. However, the issue of optimal terminology was not addressed in the guidelines. For more than 60 years, the age-related decline in testosterone production has been designated with an assortment of names, including male climacteric, male menopause, andropause, androgen decline in the aging male, and late onset hypogonadism (2); these poorly reflect the specific hormone deficiency state involved. We propose that the term Testosterone Deficiency Syndrome (TDS) is a better option due to its simplicity, accuracy and deference to physiological and etymological principles. Furthermore, for specific situations TDS can be easily qualified, for example, in association with aging, diabetes, erectile dysfunction, obesity, or metabolic syndrome. We make no claim to originality since TDS has already been used in the literature, sporadically and interchangeably, with the terms mentioned above. In fact, the guidelines referred to deficiency syndromes, but mentioned androgens in general when they should have referred to testosterone specifically. There is insufficient evidence to include other androgens, e.g., DHEA and androstenedione, and DHT is generated locally in target tissues. We also believe that highlighting the deficiency by the specific hormone concerned is a more precise reflection of the clinical syndrome than the term hypogonadism, which implies an underlying pathological state and is, therefore, distinct from physiological causes of testosterone deficiency, such as aging. Without diminishing, in any way, the timeliness and relevance of the outstanding Society’s Guidelines, this is a fitting and ideal opportunity for naming the described syndrome appropriately once and for all. References 1. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. 2006. J Clin Endocrinol Metab 91: 1995-2010 2. Morales A, Heaton JPW, Carson C. Andropause: a misnomer for a true clinical entity. 2000. J Urol. 163:705-709