Testosterone Replacement Therapy for Male Hypogonadism.

Testosterone replacement therapy may improve sexual function, depressive symptoms, bone density, and lean body mass in men with hypogonadism.

• Studies suggest benefits across multiple domains including sexual function, mood, and body composition.
• The paper describes testosterone deficiency as 'a clinical syndrome that can be defined as persistently low serum testosterone levels in the setting of symptoms consistent with testosterone deficiency.'
• Treatment is intended 'to correct selected symptoms and induce and maintain secondary sex characteristics.'

A large randomized trial showed that testosterone replacement therapy does not increase the risk of myocardial infarction or stroke, even in patients at high cardiovascular risk.

• Prior studies had suggested that testosterone replacement therapy increased the risk of cardiovascular disease.
• The large randomized trial directly contradicted earlier concerns about cardiovascular safety.
• Evidence is described as 'conflicting regarding its effect on cardiovascular events and mortality.'
• The finding applied specifically 'even in patients at high risk' for cardiovascular events.

Shared decision-making should precede initiation of testosterone replacement therapy, with treatment method individualized to the patient.

• Treatment method should consider 'patient preference, pharmacokinetics, potential for medication interactions, formulation-specific adverse effects, treatment burden, and cost.'
• A 'detailed discussion of the potential benefits and risks through shared decision-making' is recommended before initiating therapy.
• Clinicians should monitor for 'symptom improvement, potential adverse effects, and adherence.'

Serum testosterone, hematocrit, and prostate-specific antigen levels should be measured at baseline and at least annually in men aged 40 years or older receiving testosterone replacement therapy.

• Monitoring applies to men 40 years or older receiving testosterone replacement therapy.
• Three specific laboratory parameters are identified: serum testosterone, hematocrit, and prostate-specific antigen (PSA).
• Baseline measurements are required in addition to ongoing annual monitoring.