The Fifth International Consultation on Sexual Medicine (ICSM 2024) generated clinically effective recommendations for 14 categories concerning hypogonadism diagnosis and 15 categories on testosterone therapy, based on a narrative review of peer-reviewed literature combined with expert consensus.
Key Findings
Background
Male hypogonadism is defined as a clinical condition combining low circulating testosterone and specific signs and symptoms associated with impaired hormone production.
The definition requires both biochemical (low testosterone) and clinical (signs and symptoms) components.
The condition is associated with sexual dysfunction and male factor infertility.
The panel emphasized 'critical interpretation of the hypogonadal conditions associated with sexual dysfunction and male factor infertility.'
The physiological role of testosterone throughout the male aging process was specifically reappraised.
Methods
The expert panel generated recommendations across 14 categories concerning hypogonadism diagnosis.
Recommendations were based on the quality of evidence and criteria of Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Individual study quality was judged using Oxford levels of evidence (LOEs) criteria.
Overall LOEs were not applied as a systematic review was not performed.
Relevant English-language peer-reviewed literature was reviewed with a focus on research from the last 10 years.
Results
The expert panel generated recommendations across 15 categories on testosterone therapy.
Treatment options for hypogonadism were among the major topics addressed.
Topics covered included cardiovascular, metabolic, sexual, and reproductive health impacts of testosterone.
Prostate cancer (PCa) survivorship was specifically addressed as a clinically relevant topic.
The recommendations were described as 'clinically effective.'
Results
Cardiovascular health was identified as a relevant clinical topic requiring specific attention in the management of male hypogonadism.
Testosterone's impact toward cardiovascular health was included as a major topic of the consensus review.
Cardiovascular health was listed alongside metabolism and bone safety as everyday clinical topics warranting particular attention.
The review addressed these topics in the context of testosterone therapy management.
Results
Prostate cancer survivorship was addressed as a specific clinical topic within the hypogonadism management recommendations.
PCa survivorship was explicitly listed as a topic receiving 'particular attention' in the clinical review.
The panel addressed testosterone therapy in the context of prostate cancer survivorship.
This reflects evolving clinical considerations around testosterone use in men with a history of prostate cancer.
Results
Metabolic health and bone safety were identified as important clinical considerations in the management of male hypogonadism.
Metabolism and bone safety were listed as 'relevant everyday clinical topics' requiring particular attention.
These topics were addressed within the framework of testosterone therapy recommendations.
The panel's recommendations covered testosterone's impact toward metabolic health as a major topic.
Discussion
The narrative review design was identified as both the main strength and limitation of the consensus paper.
The authors stated: 'The combined main strength and limitation is the narrative profile of this literature review.'
The narrative approach was described as 'intentionally devoted to addressing the critical clinical aspects of male hypogonadism.'
The paper explicitly does not provide a systematic review or meta-analysis.
A consensus panel was convened with leading Sexual Medicine experts during the 5th ICSM.
Results
Sexual dysfunction and male factor infertility are key clinical manifestations of hypogonadism requiring critical interpretation in diagnosis and management.
The manuscript gave emphasis to 'the critical interpretation of the hypogonadal conditions associated with sexual dysfunction and male factor infertility.'
Reproductive health was listed as one of the major topics concerning testosterone's clinical impact.
Sexual health impact of testosterone was addressed as a distinct major topic alongside cardiovascular and metabolic health.
What This Means
This research presents updated clinical recommendations from an international panel of sexual medicine experts on how to diagnose and treat male hypogonadism — a condition where men have low testosterone levels along with related symptoms such as sexual dysfunction, fatigue, or reduced fertility. The panel reviewed recent scientific literature and reached consensus on 14 areas related to diagnosis and 15 areas related to testosterone treatment, covering topics such as heart health, bone health, metabolism, fertility, and cancer survivorship.
The recommendations reflect a nuanced view of testosterone therapy, acknowledging its effects across multiple body systems. Notably, the panel addressed testosterone use in men who have survived prostate cancer — an area that has historically been controversial — as well as its role in men experiencing infertility. The experts used established grading systems to rate the strength of their recommendations based on available evidence.
This research suggests that the field of male hypogonadism management has evolved significantly, with growing evidence supporting broader consideration of testosterone therapy across different patient groups, including those with cardiovascular risk factors or a history of prostate cancer. Because this is a narrative expert consensus rather than a systematic review or meta-analysis, its recommendations reflect both the available published evidence and the collective clinical judgment of leading specialists, which may be particularly useful for guiding everyday clinical practice.
Khera M, Torres L, Grober E, Morgentaler A, Miner M, Jones T, et al.. (2025). Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).. Sexual medicine reviews. https://doi.org/10.1093/sxmrev/qeaf036