May 01, 2019
How do healthcare professionals make decisions when diagnosing and treating illnesses? Certainly, their continuing medical education helps, and most attend conferences and keep up with research in their field’s peer-reviewed journals.
But professionals also consult guidelines issued by medical societies, such as the International Society for Sexual Medicine (ISSM) or the American Urological Association (AUA). Society panels take a close look at the latest clinical trials and other studies and use that evidence to develop recommendations.
Over the last few years, testosterone replacement therapy has been a hot topic for medical societies. Back in August of last year, we covered new guidelines from the American Urological Society. Today, we’ll discuss a set of guidelines that were updated by the Endocrine Society, a professional group of over 18,000 hormone specialists.
Since testosterone is an important hormone for men, the list of guidelines can be an essential tool for sexual health specialists and primary care physicians who treat men with hypogonadism (low testosterone).
The Endocrine Society guidelines were originally issued in 2010 and updated in 2018.
(Note: For a primer on hypogonadism, please see the links at the bottom of this post.)
Why were the guidelines updated?
Scientists have conducted a great deal of research on testosterone therapy in recent years. The updated guidelines reflect new findings and address concerns.
In addition, more men are seeking help for issues related to testosterone deficiency nowadays, and “low t” gets a lot of media coverage. As a result, men are asking their doctors whether testosterone therapy could help them. It’s critical that prescribers fully understand the benefits and risks.
What do the updated guidelines say?
Highlights of the Endocrine Society’s updated guidelines on hypogonadism include the following points:
- In general, men shouldn’t be routinely screened for hypogonadism. However, a diagnosis of hypogonadism is recommended if a man has symptoms (such as low libido or fatigue), and a blood test reveals lower-than-normal testosterone levels.
- Based on other hormonal measurements, men can be diagnosed with primary hypogonadism (caused by problems in the testes) or secondary hypogonadism (caused by problems in parts of the brain that trigger testosterone production).
- The recommended goals of testosterone therapy are to “induce and maintain” secondary sex characteristics that are driven by testosterone (such as facial hair and muscle mass) and to alleviate symptoms like low sex drive.
- Testosterone therapy is not recommended for men who would like to father a child in the near future. Men with certain health problems (such as prostate cancer, breast cancer, untreated severe obstructive sleep apnea, and recent heart attack or stroke) should not take testosterone.
- Testosterone therapy might not be appropriate for men between the ages of 55 and 69 who are expected to live at least another ten years. Doctors should discuss the benefits and risks with these patients.
- Men over age 65 shouldn’t be prescribed testosterone routinely. Instead, doctors should consider each individual’s situation.
- Men with HIV, low testosterone, and weight loss might undergo testosterone therapy to gain and maintain weight.
- Men with diabetes and low testosterone should not use testosterone as a way to control their blood sugar.
- Once testosterone therapy has begun, men should have regular checkups to make sure it is working well and there are no side effects.
- During the first year of therapy, men with abnormal prostate cancer screening results should see a urologist.
What does this mean for patients?
While these guidelines are intended for healthcare professionals, they can be useful for men, too.
Understanding the guidelines for any treatment you receive helps you weigh the pros and cons of therapy as you make health decisions.
“The [updated Endocrine Society] guideline emphasizes the importance of patient engagement in a shared decision-making process, especially with respect to the choice of treatment regimens and prostate monitoring,” said Dr. Shalender Bhasin, head of the guideline development task force, in an interview with Endocrine News.
For more information on hypogonadism and testosterone, please see these links:
“Q&A: Shalender Bhasin, MD”
The Endocrine Society
“About the Endocrine Society”
“Testosterone Therapy for Hypogonadism Guideline Resources”
The Journal of Clinical Endocrinology and Metabolism
Bhasin, Shalender, et al.
“Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline”
(Full-text. Published: March 17, 2018)