Magazine article Clinical Psychiatry News

Testosterone Replacement Options: Revised Guidelines Address Diagnosing and Treating Hypogonadism in Men

Magazine article Clinical Psychiatry News

Testosterone Replacement Options: Revised Guidelines Address Diagnosing and Treating Hypogonadism in Men

Article excerpt

Updated guidelines on the diagnosis and treatment of hypogonadism in men reflect advances in treatment and more robust data about the short-term benefits of testosterone replacement therapy.

The guidelines, issued by the American Association of Clinical Endocrinologists (AACE), also urge additional research into the long-term use of the therapy and its possible effects on the risk of cancer and cardiovascular disease. "Concern about long-term safety and efficacy remains an issue," said Dr. Steven M. Petak, chair of the guidelines revision committee.

The National Institute on Aging has begun work on a 1-year study to evaluate the feasibility of conducting clinical trials of testosterone replacement therapy in older men. A task force will report on the known benefits and risks of the therapy, its potential public health impact, and the ethical issues involved in conducting such a clinical trial. The report is expected by November, said Dr. Stanley Slater, deputy director of the institute's geriatrics and clinical gerontology program.

The new AACE guidelines include a detailed discussion of clinical and laboratory findings, as well as a diagnosis and treatment algorithm based on testicular size, hormone levels, and semen analysis.

It's important to focus attention on the recognition and treatment of the disorder because many men are reluctant to discuss the symptoms of hypogonadism with their physicians, Dr. Petak said. Symptoms usually include decreased libido, impotence, decreased muscle mass, fatigue, and decreased bone density.

"Many men don't seek out medical attention for health problems in the early stage," he said, "And they don't feel comfortable talking about the major symptom, loss of libido."

Even if patients do mention decreased sexual urge, physicians might be more likely to prescribe Viagra than to perform a full evaluation. "Lots of physicians don't delve into the matter too deeply, either for lack of time or because of the level of discomfort," Dr. Petak said. A thorough evaluation is important because hypogonadism may be caused by conditions associated with the testes, pituitary, or hypothalamus, or by a genetic disorder.

The AACE guidelines are aimed at three target populations:

* Men with primary testicular failure who require hormone replacement. …

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