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EMAS position statement: Testosterone replacement therapy in older men.

George A Kanakis1, Riccardo Pofi2, Dimitrios G Goulis3

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Testosterone replacement therapy (TRT) is recommended for symptomatic older men with confirmed low testosterone, balancing benefits against uncertain long-term safety. TRT may improve sexual function, insulin resistance, and quality of life in select cases.

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Area of Science:

  • Geriatric Medicine
  • Endocrinology
  • Men's Health

Background:

  • Late-onset hypogonadism (LOH) in aging men presents with low testosterone and symptoms, linked to metabolic syndrome, reduced bone density, and cardiovascular risks.
  • While testosterone replacement therapy (TRT) benefits younger men, its risk/benefit profile in older men remains debated.

Purpose of the Study:

  • To provide an updated evidence-based statement on the use of TRT in older men with LOH.
  • To incorporate recent research findings into clinical recommendations.

Main Methods:

  • Comprehensive literature review of recent studies on LOH and TRT.
  • Consensus development based on expert opinion.

Main Results:

  • TRT is advised for symptomatic older men with confirmed low testosterone, with careful consideration of long-term safety uncertainties.
  • TRT may benefit specific conditions like erectile dysfunction, severe insulin resistance, osteoporosis, and depressive symptoms.
  • TRT is contraindicated in men seeking fertility, with active cancer, recent cardiovascular events, or severe heart failure.

Conclusions:

  • TRT decisions for older men must be individualized, weighing perceived benefits against risks.
  • Monitoring of testosterone levels, haematocrit, PSA, and clinical response is crucial.
  • Lifestyle modifications are essential for obese/overweight men to enhance endogenous testosterone.