Approach to the Patient: The Evaluation and Management of Men ≥50 Years With Low Serum Testosterone Concentration.

Testosterone replacement in men with classic hypogonadism due to identified pathology is uncontroversial, but its role for age-related testosterone decline is unclear.

• The lack of large, long-term testosterone therapy trials assessing definitive clinical endpoints contributes to this uncertainty.
• Men ≥50 years, particularly those with BMI >25 kg/m2 and multiple comorbidities, commonly present with clinical features of androgen deficiency and low serum testosterone.
• The decision to initiate testosterone therapy requires a benefit-risk analysis with limited evidence from clinical trials.

Men ≥50 years with BMI >25 kg/m2 and multiple comorbidities represent a common clinical presentation of low testosterone with symptoms of androgen deficiency.

• This population presents a difficult dilemma for clinicians regarding whether to initiate testosterone therapy.
• The authors used a case scenario to illustrate a practical approach to clinical assessment and management.
• The overlap of symptoms of androgen deficiency with those of comorbid conditions complicates clinical decision-making in this population.

A practical clinical approach to evaluation and management of low testosterone in older men is presented using a case scenario framework.

• The approach addresses clinical assessment steps and management decisions for men ≥50 years with low serum testosterone.
• The framework is intended to help clinicians navigate the benefit-risk analysis given limited trial evidence.
• The case-based approach is designed to be applicable to men with age-related rather than pathology-identified hypogonadism.