Summary: Urological referral inappropriate; refer to Endocrinologists
Advice: If referral is required for men with low testosterone levels, this should be to the Endocrinology Department
Refer To: Endocrinologists
- Indications for treatment
- Contra-indications to treatment
- Monitoring treatment
- Further information
- Useful links
Referral is only indicated in men who have consistent symptoms & signs with unquivocally low serum testosterone levels. Diagnosis should be confirmed by measurement of morning total testosterone levels and, in a few patients, by free (bioavailable) testosterone levels.
Indications for treatment
Testosterone replacement therapy should be instigated only:
- to induce & maintain secondary sex characteristics
- to improve sexual function & libido
- to improve general malaise
- to increase muscle mass & muscle strength
- to increase bone mineral density
The actual formulation used should be chosen on the basis of patient preference, pharmacokinetics, treatment burden & cost.
Contra-indications to treatment
Testosterone replacement therapy should not be started in men with:
- breast or prostate cancer
- a palpable prostatic nodule or induration
- PSA greater than 3 ng/ml (requires urological evaluation)
- erythrocytosis (PCV greater than 50%)
- untreated obstructive sleep apnoea
- severe LUTS with I-PSS greater than 19/35
- class III or IV heart failure
The aim should be to achieve testosterone levels in the mid-normal range using any of the approved formulations. Men receiving treatment should be monitored using a standardised plan.
These recommendations have been prepared by the Clinical Guidelines Subcommittee of the Endocrine Society and represent a consensus opinion based on strength of recommendations and quality of evidence.
The full guidance is published in J Clin Endocrinol Metab (2006), 91, 1995-2010 or use the download below.