Case scenarios in androgen deficiency

Deciding whether to choose androgen replacement for a particular patient is one of the many tasks facing the urologist. Factors including androgen levels, medical history, symptom profile, current medications, and prostate cancer risk all need to be considered when making this decision. However, the role each of these factors plays in arguing for or against androgen replacement remains controversial and more research is needed in many of these areas before the outstanding issues can be resolved. This article presents three cases involving patients who may require androgen supplementation. The cases describe (1) partial androgen deficiency syndrome, (2) testosterone deficiency in an anorchic man after bilateral orchiectomy for seminoma, and (3) a patient with sildenafil-refractory erectile dysfunction following treatment of localized prostate cancer with radiation therapy and androgen ablation. These cases illustrate some of the dilemmas and controversies surrounding androgen replacement that face the practicing urologist.