Diagnosis and Treatment of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)
- PMID:27914560
- DOI: 10.1016/j.jsxm.2016.10.009
Diagnosis and Treatment of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)
Abstract
Introduction: Testosterone deficiency (TD), also known as hypogonadism, is a condition affecting a substantial proportion of men as they age. The diagnosis and management of TD can be challenging and clinicians should be aware of the current literature on this condition.
Aim: To review the available literature concerning the diagnosis and management of TD and to provide clinically relevant recommendations from the Fourth International Consultation for Sexual Medicine (ICSM) meeting.
Methods: A literature search was performed using the PubMed database for English-language original and review articles published or e-published up to January 2016.
Main outcome measures: Levels of evidence (LoEs) and grades of recommendations are provided based on a thorough analysis of the literature and committee consensus.
Results: Recommendations were given for 12 categories of TD: definition, clinical diagnosis, routine measurement, screening questionnaires, laboratory diagnosis, threshold levels for the biochemical diagnosis of TD, prostate cancer, cardiovascular disease, fertility, testosterone (T) formulations, alternatives to T therapy, and adverse events and monitoring. A total of 42 recommendations were made: of these, 16 were unchanged from the Third ICSM and 26 new recommendations were made during this Fourth ICSM. Most of these recommendations were supported by LoEs 2 and 3. Several key new recommendations include the following: (i) the clinical manifestations of TD occur as a result of decreased serum androgen concentrations or activity, regardless of whether there is an identified underlying etiology [LoE = 1, Grade = A]; (ii) symptomatic men with total T levels lower than 12 nmol/L or 350 ng/dL should be treated with T therapy [LoE = 1, Grade = C]; (iii) a trial of T therapy in symptomatic men with total T levels higher than 12 nmol/L or 350 ng/dL can be considered based on clinical presentation [LoE = 3, Grade = C]; (iv) there is no compelling evidence that T treatment increases the risk of developing prostate cancer or that its use is associated with prostate cancer progression [LoE = 1, Grade = C]; and (v) the weight of evidence indicates that T therapy is not associated with increased cardiovascular risk [LoE = 2, Grade = B].
Conclusion: TD is an important condition that can profoundly affect the sexual health of men. We provide guidance regarding its diagnosis and management. Men with TD who receive treatment often experience resolution or improvement in their sexual symptoms and non-sexual health benefits.
Keywords: Androgens; Cardiovascular Disease; Hypogonadism; Prostate Cancer; Testosterone Deficiency.
Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Similar articles
- Diagnosis and Treatment of Testosterone Deficiency: Updated Recommendations From the Lisbon 2018 International Consultation for Sexual Medicine.Morgentaler A, Traish A, Hackett G, Jones TH, Ramasamy R.Morgentaler A, et al.Sex Med Rev. 2019 Oct;7(4):636-649. doi: 10.1016/j.sxmr.2019.06.003. Epub 2019 Jul 24.Sex Med Rev. 2019.PMID:31351915Review.
- The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men.Dean JD, McMahon CG, Guay AT, Morgentaler A, Althof SE, Becher EF, Bivalacqua TJ, Burnett AL, Buvat J, El Meliegy A, Hellstrom WJ, Jannini EA, Maggi M, McCullough A, Torres LO, Zitzmann M.Dean JD, et al.J Sex Med. 2015 Aug;12(8):1660-86. doi: 10.1111/jsm.12952.J Sex Med. 2015.PMID:26081680Review.
- Negative Impact of Testosterone Deficiency and 5α-Reductase Inhibitors Therapy on Metabolic and Sexual Function in Men.Traish AM.Traish AM.Adv Exp Med Biol. 2017;1043:473-526. doi: 10.1007/978-3-319-70178-3_22.Adv Exp Med Biol. 2017.PMID:29224108Review.
- Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, Snyder PJ, Swerdloff RS, Wu FC, Yialamas MA.Bhasin S, et al.J Clin Endocrinol Metab. 2018 May 1;103(5):1715-1744. doi: 10.1210/jc.2018-00229.J Clin Endocrinol Metab. 2018.PMID:29562364
- Sexual Rehabilitation After Treatment for Prostate Cancer-Part 1: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015).Salonia A, Adaikan G, Buvat J, Carrier S, El-Meliegy A, Hatzimouratidis K, McCullough A, Morgentaler A, Torres LO, Khera M.Salonia A, et al.J Sex Med. 2017 Mar;14(3):285-296. doi: 10.1016/j.jsxm.2016.11.325.J Sex Med. 2017.PMID:28262099
Cited by
- Prevalence of and risk factors for erectile dysfunction in young nondiabetic obese men: results from a regional study.Molina-Vega M, Asenjo-Plaza M, Banderas-Donaire MJ, Hernández-Ollero MD, Rodríguez-Moreno S, Álvarez-Millán JJ, Cabezas-Sanchez P, Cardona-Díaz F, Alcaide-Torres J, Garrido-Sánchez L, Castellano-Castillo D, Tinahones FJ, Fernández-García JC.Molina-Vega M, et al.Asian J Androl. 2020 Jul-Aug;22(4):372-378. doi: 10.4103/aja.aja_106_19.Asian J Androl. 2020.PMID:31603141Free PMC article.
- HC diet inhibited testosterone synthesis by activating endoplasmic reticulum stress in testicular Leydig cells.Yu C, Jiang F, Zhang M, Luo D, Shao S, Zhao J, Gao L, Zuo C, Guan Q.Yu C, et al.J Cell Mol Med. 2019 May;23(5):3140-3150. doi: 10.1111/jcmm.14143. Epub 2019 Mar 18.J Cell Mol Med. 2019.PMID:30884106Free PMC article.
- Pubertal attainment and Leydig cell function following pediatric hematopoietic stem cell transplantation: a three-decade longitudinal assessment.Cattoni A, Nicolosi ML, Capitoli G, Gadda A, Molinari S, Louka S, Buonsante A, Orlandi S, Salierno G, Bellani I, Vendemini F, Ottaviano G, Gaiero A, Fichera G, Biondi A, Balduzzi A.Cattoni A, et al.Front Endocrinol (Lausanne). 2023 Dec 13;14:1292683. doi: 10.3389/fendo.2023.1292683. eCollection 2023.Front Endocrinol (Lausanne). 2023.PMID:38152128Free PMC article.
- A New LC-MS/MS Method for Simultaneous and Quantitative Detection of Bisphenol-A and Steroids in Target Tissues: A Power Tool to Characterize the Interference of Bisphenol-A Exposure on Steroid Levels.Errico S, Chioccarelli T, Moggio M, Diano N, Cobellis G.Errico S, et al.Molecules. 2019 Dec 21;25(1):48. doi: 10.3390/molecules25010048.Molecules. 2019.PMID:31877782Free PMC article.
- [Adverse effects of opioids, antidepressants and anticonvulsants on sex hormones : Often unnoticed but clinically relevant].Wirz S, Schenk M, Kieselbach K.Wirz S, et al.Schmerz. 2022 Aug;36(4):293-307. doi: 10.1007/s00482-022-00655-9. Epub 2022 Jul 13.Schmerz. 2022.PMID:35831621German.
Publication types
MeSH terms
Substances
Related information
LinkOut - more resources
Full Text Sources
Other Literature Sources