Androgen deficiency

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



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.

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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.

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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%)
  • hyperviscosity
  • untreated obstructive sleep apnoea
  • severe LUTS with I-PSS greater than 19/35
  • class III or IV heart failure

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Monitoring treatment

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.

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Further information

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.

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