BUSM: Testosterone deficiency and replacement therapy in men

Testosterone deficiency (TD), often referred to as hypogonadism, is associated with aging and affects approximately 30 percent of men ages 40-79. To highlight some of the challenges and controversies encountered in diagnosis and treatment of men with TD, the authors of a review article in the American Journal of Medicine introduced a clinical vignette to illustrate the implication of TD on men's overall health and analyzed a number of studies in men receiving Testosterone Replacement Therapy (TRT) to treat TD. The article also provided an algorithm for diagnosis and treatment and addressed the areas of concern and uncertainty involving testosterone replacement therapy (TRT). The clinical vignette depicted a 52 year old man of Caucasian descent who presented with erectile dysfunction, diminished libido and fatigue. He was 5 feet, 7 inches tall, weighed 217 pounds and had normal blood and laboratory values, except that his blood pressure was high and his serum total testosterone was low and his fasting serum glucose and lipid profiles were high –indicating the presence of metabolic syndrome.

In conclusion, the authors recommend that the man be treated for 2-3 months using TRT, with a follow up to determine the efficacy of the TRT in increasing his testosterone levels to normal levels. Their recommendations are in agreement with many published guidelines and show that the TRT treatment, in conjunction with diet and exercise, will help improve the man's sexual and physical health.

"This clinical vignette offers important information for general practitioners and provides practical recommendations for diagnosing TD and the novel treatment approaches that could positively impact the overall health of middle-aged men," said Traish.

By introducing the clinical vignette as a teaching case study the authors re-focused the attention on utilizing not only blood (serum) test for testosterone, but also taking into account the sexual and non-sexual physical symptoms into considerations. The authors also indicated that current data failed to show a significant association between TRT and prostate cancer. TRT has been shown to improve sexual function in men with TD. According to a recent review article in the American Journal of Medicine, TRT might also improve the overall health of men.

Source: Boston University Medical Center