The Optimal Indication for Testosterone Replacement Therapy in Late Onset Hypogonadism

Area of Science:

• Endocrinology
• Urology
• Andrology

Background:

• Testosterone replacement therapy (TRT) use for late-onset hypogonadism (LOH) is rising annually.
• A significant percentage of men receive TRT without prior testosterone level testing, indicating potential misuse.
• There is a growing need for evidence-based guidelines on appropriate TRT indications.

Purpose of the Study:

• To provide clinicians with evidence-based information on the optimal indications for TRT in patients with LOH.
• To clarify the diagnostic criteria and threshold values for initiating TRT.

Main Methods:

• Review of recent guidelines from major international and national urology and endocrinology societies (ISSAM, EAU, ESE, EAA, AUA).
• Definition of diagnostic criteria for LOH, including characteristic signs and symptoms.
• Establishment of serum total testosterone (TT) threshold for defining low testosterone.

Main Results:

• LOH diagnosis requires both clinical signs/symptoms and decreased serum TT.
• A TT level of 250-350 ng/dL is identified as the threshold for defining low testosterone.
• The optimal indication for TRT is the presence of hypogonadism symptoms alongside low T levels, provided no contraindications exist.

Conclusions:

• TRT for LOH should be based on a confirmed diagnosis of hypogonadism, including symptoms and low testosterone levels.
• Adherence to established guidelines and threshold values is crucial for appropriate TRT prescription.
• Careful patient selection, considering contraindications, is essential for safe and effective TRT.