Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline.
Testosterone deficiency syndrome, also known as late-onset hypogonadism, is a clinical and biochemical syndrome that can occur in men in association with advancing age. The condition is characterized by deficient testicular production of testosterone. It may affect multiple organ systems and can result in substantial health consequences.1
The management of testosterone deficiency syndrome in men is associated with much controversy, creating confusion and reluctance among health practitioners in dealing with the subject. A small number of professional bodies2,3 have published guidelines on the topic, yet a multidisciplinary guideline with specific Canadian content did not exist. This is relevant because there are important differences in health care systems compared with other jurisdictions in North America and Europe, including familiarity with the concepts of adult testosterone deficiency, accessibility to some laboratory tests and availability of certain formulations of testosterone. In this article, we identify and address the knowledge gaps across disciplines to assist a variety of health professionals in their clinical decision-making in managing testosterone deficiency syndrome.
In addition to the Canada-wide survey conducted as part of our needs assessment, two recent studies support the need for an increased effort in educating physicians on the basics of managing testosterone deficiency in men. Researchers in Ontario found that 1 in 90 men over age 65 years was being prescribed testosterone replacement therapy, but only 6% of these patients had a conclusive diagnosis of hypogonadism.4 These findings are further validated by a large, long-term study conducted in the United Kingdom and the United States that showed that as many as 40% of men were obtaining testosterone without a documented biological deficiency.5
This guideline is intended to address clinical questions surrounding the diagnosis of testosterone deficiency and the appropriate use of testosterone replacement therapy in the management of these patients. The document places a high priority on the identification and treatment of symptomatic men, and the improvement of patient outcomes.