Testosterone deficiency in men. Diagnosis and management

Testosterone deficiency (hypoandrogenism) is the commonest hormonal deficiency in men but its clinical presentation may be subtle and its diagnosis overlooked unless actively considered.

This article aims to provide an overview of the presentation of hypoandrogenism and the essential diagnostic role of the endocrine laboratory. We also seek to outline current treatment options and highlight the controversial area of age related hypoandrogenism with an emphasis on results from placebo controlled studies.

The causes of hypogonadism in younger men are well documented but its presentation may be nonspecific and the diagnosis in older men may be difficult. It is likely that testosterone deficiency is widely under diagnosed. Endocrine testing provides essential supportive data for diagnosis and assists in monitoring treatment. The Endocrine Society of Australia has developed guidelines to assist practitioners in the diagnosis and management of hypoandrogenism in younger and older men. Testosterone replacement effectively restores sexual health and other androgen dependent actions on mood/cognition, muscle and bone. Testosterone treatment in symptomatic aging men with borderline hypoandrogenism is controversial and the benefits (and risks) of testosterone therapy remain uncertain.