Reviews and other considerations
by C-3PO (2012-12-27 15:35:12)
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  In reply to: Question for the BR doctors  posted by die4irish

The following are from the Cleveland Clinic Medical Journal re. male hypogonadism.

Confronted with a low serum testosterone level, physicians should not jump to the diagnosis of hypogonadism, as confirmation and thorough evaluation are warranted before making the diagnosis or starting therapy. This review discusses how to approach the finding of a low testosterone value, stressing the need to confirm the finding, the underlying pathophysiologic processes, drugs that can be responsible, and the importance of determining whether the cause is primary (testicular) or secondary (hypothalamic-pituitary).
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Key points

Blood samples for testosterone measurements should be drawn near 8 am.

A low serum testosterone value should always be confirmed by a reliable reference laboratory.

The definition of a low testosterone level varies from laboratory to laboratory. In general, values less than 200 or 250 ng/dL are considered low, and values between 250 and 350 ng/dL may be considered borderline low.

If testosterone is low, determine if the cause is primary (testicular) or secondary (hypothalamic-pituitary). Draw an LH and FSH.

Acute illness and treatment with opioids, anabolic steroids, or corticosteroids can result in transient hypogonadism.

The decline in testosterone with age has been associated with specific physical changes that affect quality of life and life expectancy, although a cause-and-effect relationship is yet to be established. While female menopause is rapid and well described, “male menopause” or androgen decline in older men is gradual and marked by nonspecific symptoms. This makes diagnosis of true testosterone deficiency and prediction of response to testosterone replacement therapy (TRT) challenging.

Key points

General health benefits and safety of TRT in asymptomatic patients are not clearly defined by current data.

Treatment of low testosterone is discouraged in the absence of clinical symptoms.

A morning serum testosterone should be obtained after ruling out other causes of symptoms. It should also be repeated to confirm androgen deficiency in older men.

Androgen deficiency in older men is associated with metabolic syndrome, type 2 diabetes mellitus, obesity, osteoporosis, renal failure, anemia, and previous treatment with steroids or opiates.

TRT in men with a history of prostate cancer remains controversial. The existing limited data suggest that TRT is safe after curative therapy for prostate cancer. Patients treated should be monitored closely and informed of the risks of cancer progression and recurrence while they are on TRT.


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