Testosterone deficiency and treatments: common misconceptions and practical guidance for patient care

Misconceptions about testosterone therapy are prevalent and there is an unmet need for a review of current literature that can be leveraged by physicians to deliver safe and effective care for men with hypogonadism.

This review aims to address common misconceptions about testosterone therapy using current literature and synthesize practical guidance for clinicians with patients who are starting testosterone therapy.

A literature search of PubMed, Embase, CINAHL was carried out to identify associations between testosterone therapy and prostate cancer, cardiovascular risk, and hepatic toxicity; definitions of hypogonadism; and practical guidance for clinician with patients starting testosterone therapy.

There is no evidence to support the misconception that testosterone therapy leads to or promotes progression of prostate cancer, no evidence that testosterone therapy increases cardiovascular risk, no evidence that newer oral testosterone therapy formulations (eg, testosterone undecanoate) are associated with hepatic toxicity, and no consistent definition of hypogonadism among regulatory agencies and expert bodies. Clinicians should diagnose hypogonadism using testosterone concentrations and/or symptoms of testosterone deficiency, help patients select a testosterone therapy formulation that best fits their needs and preferences (including considerations for dose adjustment), ensure appropriate laboratory monitoring before and during treatment, and assess how patients are feeling during treatment.

Testosterone therapy is not associated with increased prostate cancer or increased cardiovascular risk, newer oral testosterone therapy formulations are not associated with hepatic toxicity, and a strict definition of hypogonadism is difficult because patient individualization is required. Each patient in real-world clinical practices has unique baseline characteristics and will likely respond differently to testosterone therapy. As the primary goal of testosterone therapy is to provide relief from symptoms of hypogonadism, physicians should work with their male patients to create a comprehensive treatment plan that suits the patient's specific needs and preferences.