The goals of this document are to (i) guide clinicians in how to assess patients for testosterone deficiency and manage them with testosterone products, and (ii) educate clinicians in key areas of testosterone in which many clinicians are deficient (e.g., interpreting the testosterone literature, understanding testosterone laboratory testing). The explosion in the use of testosterone in the past decade is multifactorial in its etiology, including the increased use of direct-to-consumer advertising, which has resulted in greater patient knowledge and demand; relaxation of the indications for testosterone prescribing by clinicians; and the establishment of clinical care centers devoted to men's health, testosterone treatment, and anti-aging strategies. Testosterone therapy should not be commenced for a period of three to six months in patients with a history of a cardiovascular events.
In general, smaller dosages at more frequent intervals are preferred over high, less frequent administrations to limit the duration of time spent outside (above or below) the normal reference range. The optimal dosing strategy has not been defined for short-acting IM testosterone preparations. Mean testosterone values over a 7-day time period were 1,659, 896, and 422 ng/dL for IM testosterone SQ 100, and SQ 50, respectively. The half-life for IM testosterone was also shorter at 173 hours versus 240 hours for SQ testosterone.
The goal of this review is to consider strategies for individualizing testosterone therapy in the primary care setting based on the patient’s needs and the relative advantages and disadvantages of available treatment options. In addition, ongoing research aims to better characterize the effects of testosterone therapy in specific populations, such as patients aged 65 years and older, patients with obesity and type 2 diabetes, and transgender patients. The incidence of testosterone deficiency and the use of testosterone therapy have increased in recent years, and currently the majority of testosterone prescriptions in the United States and Canada are written by primary care physicians. They could measure your testosterone levels and help develop a treatment plan, if necessary. The designation of "healthy range" for testosterone levels depends on age and laboratory assay. After menopause, usually between ages 45 and 55 years, testosterone levels begin to decrease.
Another multi-center study compared the effectiveness and risks of transdermal and IM testosterone in 66 men aged years old. Clinicians should be aware that symptomatic gynecomastia or other breast symptoms are an uncommon side effect in men on testosterone therapy. Hypergonadotropic hypogonadism, which is not a contraindication to begin testosterone therapy, can result from a number of conditions, including congenital abnormalities (KS being the most common), iatrogenic causes (e.g., bilateral orchiectomy, testicular radiation, chemotherapy), testicular trauma, infection, or autoimmune damage. The validation studies for each questionnaire use a distinct total testosterone cut-off for defining low testosterone; however, total testosterone has been shown to correlate poorly with most questions.164, 165 The use of validated questionnaires is not currently recommended to either define which patients are candidates for testosterone therapy or monitor symptom response in patients on testosterone therapy.
A meta-analysis of RCTs developed in support of this guideline indicate that there is no significant difference in MACE in men on testosterone therapy when compared to placebo. RCTs have failed to categorically define if testosterone therapy increases the incidence of MACE when compared to placebo. A discussion regarding the benefit of stopping testosterone therapy should include the possibility of a decline in PSA. PSA recurrence in men on testosterone therapy should be evaluated in the same fashion as untreated men. There are limited data in men on active surveillance who are candidates for testosterone therapy.
An updated evidence search was subsequently performed in 2022. Controlled vocabulary supplemented with keywords was used to search for studies according to each defined question. You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
An exception can be made if patients do not have symptoms but have documented BMD loss. Testing intervals are the expert opinion of the Panel and are provided as a guide to aid clinicians in the follow-up of such patients. Please refer to Table 7 below for a summary of follow-up testing for men being treated for testosterone deficiency. Patients on short-acting IM or short-acting SQ pellets (testosterone cypionate or enanthate) should have their testosterone measured after several cycles such that testosterone level equilibration has been achieved.
Testosterone levels may start to decline after age 30 years in males and between ages 45 and 55 years in females. From the metabolic point of view, blood pressure, lipid profile, fasting glucose and hematocrit shall be monitored before and every 3 months on the 1st year of androgen therapy.8 Because testosterone can be aromatized in estradiol, its long-term effects on ovary, uterus and breast are not completely defined, thus screening for endometrial, ovarian, and breast cancer shall be performed in agreement with the particularities of each case. With the usual recommended therapeutic doses, amenorrhea will occur in 90% of the patients in the first 6 months, reaching almost 100% after 1 year of treatment.8 Although menstrual cycles are suspended, the endometrial evaluation in male transgenders has shown inconsistent results.

Genere : Associazione