Indications for testosterone therapy in men.

Testosterone replacement therapy for organic hypogonadism due to HPT axis disease is uncontroversial and relieves signs and symptoms of androgen deficiency.

• Organic hypogonadism results from medical disease of the hypothalamic-pituitary-testicular (HPT) axis.
• In these men, testosterone replacement replaces the deficient hormone.
• This indication is described as 'uncontroversial' in contrast to functional hypogonadism.

The role of testosterone treatment in middle-aged or older men with functional or late-onset hypogonadism has been uncertain.

• Functional hypogonadism is characterized by clinical features consistent with androgen deficiency accompanied by reductions in serum testosterone.
• These men lack identifiable HPT axis disease.
• This scenario is 'sometimes referred to as functional or late onset hypogonadism.'
• Three large randomized controlled clinical trials have addressed this uncertainty.

Three large randomized controlled clinical trials have reported new data on short-term to medium-term benefits and risks of testosterone therapy in middle-aged and older men.

• The trials examined effects on sexual function, vitality, cognition and mood, glucose metabolism, physical function, and hematologic parameters.
• Bone, cardiovascular, and prostate health outcomes were also assessed.
• The duration of these trials covered short-term to medium-term follow-up.
• Findings allow for 'a more nuanced, personalized approach to testosterone therapy in such men.'

Long-term benefits and risks of testosterone therapy in middle-aged and older men remain unknown.

• The knowledge gap pertains to outcomes beyond 3-4 years of testosterone therapy.
• This limitation applies specifically to men with functional or late-onset hypogonadism.
• The existing trial data only cover short-term to medium-term outcomes.