New guideline offers recommendations for testosterone replacement therapy use
· News-Medical1. The focus should be on having an accurate diagnosis from a clinician.
- Terms like "age-related," "late-onset," and "functional" hypogonadism are hard to define operationally and blur the line between treatable disease and normal aging.
- Healthcare providers must weigh the benefits of testosterone replacement therapy (TRT) against the risks.
2. While recent studies have addressed some concerns, we need more research to fully understand TRT's risks.
- The TRAVERSE trials (more than 5,200 men) found no meaningful increase in heart attack and stroke over a 1- to 4-year period.
- Screening and monitoring are needed if testosterone therapy is initiated. Prostate cancer develops slowly, and trials may not have followed men long enough, so risk assessment before starting treatment and careful monitoring during treatment remain essential.
- The Society is calling for a long-term "Men's Health Initiative," analogous to the Women's Health Initiative, to close evidence gaps.
3. Consistent diagnosis and testing quality would ensure the men who need treatment receive it.
- Testing is often inaccurate. Non-standardized assays mean the same blood sample can read "low" or "normal," depending on the lab and method. This drives both over- and under-diagnosis.
- Hypogonadism diagnosis should be made by a healthcare provider based on at least two early-morning, fasting testosterone tests (common clinical threshold near 300 ng/dL).
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