Testosterone deficiency and treatments: common misconceptions and practical guidance for patient care.

There is no evidence that testosterone therapy leads to or promotes progression of prostate cancer.

• The review identified no evidence supporting the misconception that testosterone therapy causes or promotes prostate cancer progression.
• Literature search covered PubMed, Embase, and CINAHL databases.
• The paper addresses this as a prevalent misconception among clinicians and patients.
• The authors note this misconception represents an unmet need for clinician education.

There is no evidence that testosterone therapy increases cardiovascular risk.

• The review found no evidence supporting the misconception that testosterone therapy increases cardiovascular risk.
• This finding was based on a systematic literature search across PubMed, Embase, and CINAHL.
• Cardiovascular risk was identified as one of the major areas of misconception among clinicians.
• The authors synthesize this as practical guidance for clinicians managing patients starting testosterone therapy.

Newer oral testosterone therapy formulations, such as testosterone undecanoate, are not associated with hepatic toxicity.

• The review found no evidence linking newer oral testosterone therapy formulations (e.g., testosterone undecanoate) to hepatic toxicity.
• This distinguishes newer formulations from older oral testosterone formulations, which have historically been associated with liver concerns.
• Hepatic toxicity was identified as a common misconception that may deter appropriate prescribing.
• The finding is specifically qualified to newer formulations, not all oral testosterone products.

There is no consistent definition of hypogonadism among regulatory agencies and expert bodies.

• The review found no uniform definition of hypogonadism across regulatory agencies and expert organizations.
• The authors state that 'a strict definition of hypogonadism is difficult because patient individualization is required.'
• Clinicians are advised to diagnose hypogonadism using testosterone concentrations and/or symptoms of testosterone deficiency.
• The lack of a consistent definition was identified through literature search as a key challenge for clinical practice.

Clinicians should follow a practical framework when initiating testosterone therapy in patients, including formulation selection, laboratory monitoring, and symptom assessment.

• Practical guidance includes helping patients select a testosterone therapy formulation that best fits their needs and preferences, including considerations for dose adjustment.
• Appropriate laboratory monitoring is recommended both before and during treatment.
• Clinicians are advised to assess how patients are feeling during treatment as part of ongoing management.
• The authors emphasize that 'each patient in real-world clinical practices has unique baseline characteristics and will likely respond differently to testosterone therapy.'
• The primary goal of testosterone therapy is described as providing 'relief from symptoms of hypogonadism.'