Diagnosis and Treatment of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)

被引:122
作者
Khera, Mohit [1 ]
Adaikan, Ganesh [2 ]
Buvat, Jacques [3 ]
Carrier, Serge [4 ]
El-Meliegy, Amr [5 ]
Hatzimouratidis, Kostas [6 ]
McCullough, Andrew [7 ]
Morgentaler, Abraham [8 ,9 ]
Torres, Luiz Otavio [10 ]
Salonia, Andrea [11 ]
机构
[1] Baylor Coll Med, Scott Dept Urol, 7200 Cambridge St,10th Floor, Houston, TX 77030 USA
[2] Natl Univ Singapore, Natl Univ Hosp, Sect Sexual Med Obstet & Gynaecol, Singapore, Singapore
[3] CETPARP Ctr Etud & Traitement Pathol Appareil Rep, Lille, France
[4] McGill Univ, Dept Urol, Montreal, PQ, Canada
[5] Dr Soliman Fakeeh Hosp, Dept Androl, Jeddah, Saudi Arabia
[6] Aristotle Univ Thessaloniki, Dept Urol 2, Pefka Thessaloniki, Greece
[7] Albany Med Ctr, Dept Urol, Albany, NY USA
[8] Mens Hlth Boston, Boston, MA USA
[9] Harvard Med Sch, Boston, MA USA
[10] Ctr Univ UniBH, Belo Horizonte, MG, Brazil
[11] Univ Vita Salute San Raffaele, Milan, Italy
关键词
Testosterone Deficiency; Androgens; Hypogonadism; Prostate Cancer; Cardiovascular Disease; LATE-ONSET HYPOGONADISM; STANDARD OPERATING PROCEDURES; PROSTATE-SPECIFIC ANTIGEN; PLACEBO-CONTROLLED TRIAL; LOWER URINARY-TRACT; SERUM TESTOSTERONE; OLDER MEN; AROMATASE INHIBITION; REPLACEMENT THERAPY; ANDROGEN DEFICIENCY;
D O I
10.1016/j.jsxm.2016.10.009
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Testosterone deficiency (TD), also known as hypogonadism, is a condition affecting a substantial proportion of men as they age. The diagnosis and management of TD can be challenging and clinicians should be aware of the current literature on this condition. Aim: To review the available literature concerning the diagnosis and management of TD and to provide clinically relevant recommendations from the Fourth International Consultation for Sexual Medicine (ICSM) meeting. Methods: A literature search was performed using the PubMed database for English-language original and review articles published or e-published up to January 2016. Main Outcome Measures: Levels of evidence (LoEs) and grades of recommendations are provided based on a thorough analysis of the literature and committee consensus. Results: Recommendations were given for 12 categories of TD: definition, clinical diagnosis, routine measurement, screening questionnaires, laboratory diagnosis, threshold levels for the biochemical diagnosis of TD, prostate cancer, cardiovascular disease, fertility, testosterone (T) formulations, alternatives to T therapy, and adverse events and monitoring. A total of 42 recommendations were made: of these, 16 were unchanged from the Third ICSM and 26 new recommendations were made during this Fourth ICSM. Most of these recommendations were supported by LoEs 2 and 3. Several key new recommendations include the following: (i) the clinical manifestations of TD occur as a result of decreased serum androgen concentrations or activity, regardless of whether there is an identified underlying etiology [LoE = 1, Grade = A]; (ii) symptomatic men with total T levels lower than 12 nmol/L or 350 ng/dL should be treated with T therapy [LoE = 1, Grade = C]; (iii) a trial of T therapy in symptomatic men with total T levels higher than 12 nmol/L or 350 ng/dL can be considered based on clinical presentation [LoE = 3, Grade = C]; (iv) there is no compelling evidence that T treatment increases the risk of developing prostate cancer or that its use is associated with prostate cancer progression [LoE = 1, Grade = C]; and (v) the weight of evidence indicates that T therapy is not associated with increased cardiovascular risk [LoE = 2, Grade = B]. Conclusion: TD is an important condition that can profoundly affect the sexual health of men. We provide guidance regarding its diagnosis and management. Men with TD who receive treatment often experience resolution or improvement in their sexual symptoms and non-sexual health benefits. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:1787 / 1804
页数:18
相关论文
共 96 条
[1]   Prevalence and incidence of androgen deficiency in middle-aged and older men: Estimates from the Massachusetts Male Aging Study [J].
Araujo, AB ;
O'Donnell, AB ;
Brambilla, DJ ;
Simpson, WB ;
Longcope, C ;
Matsumoto, AM ;
McKinlay, JB .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2004, 89 (12) :5920-5926
[2]   Prevalence of symptomatic androgen deficiency in men [J].
Araujo, Andre B. ;
Esche, Gretchen R. ;
Kupelian, Varant ;
O'Donnell, Amy B. ;
Travison, Thomas G. ;
Williams, Rachel E. ;
Clark, Richard V. ;
McKinlay, John B. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2007, 92 (11) :4241-4247
[3]   Long-acting testosterone injections for treatment of testosterone deficiency after brachytherapy for prostate cancer [J].
Balbontin, Felipe G. ;
Moreno, Sergio A. ;
Bley, Enrique ;
Chacon, Rodrigo ;
Silva, Andres ;
Morgentaler, Abraham .
BJU INTERNATIONAL, 2014, 114 (01) :125-130
[4]   Adverse Events Associated with Testosterone Administration [J].
Basaria, Shehzad ;
Coviello, Andrea D. ;
Travison, Thomas G. ;
Storer, Thomas W. ;
Farwell, Wildon R. ;
Jette, Alan M. ;
Eder, Richard ;
Tennstedt, Sharon ;
Ulloor, Jagadish ;
Zhang, Anqi ;
Choong, Karen ;
Lakshman, Kishore M. ;
Mazer, Norman A. ;
Miciek, Renee ;
Krasnoff, Joanne ;
Elmi, Ayan ;
Knapp, Philip E. ;
Brooks, Brad ;
Appleman, Erica ;
Aggarwal, Sheetal ;
Bhasin, Geeta ;
Hede-Brierley, Leif ;
Bhatia, Ashmeet ;
Collins, Lauren ;
LeBrasseur, Nathan ;
Fiore, Louis D. ;
Bhasin, Shalender .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (02) :109-122
[5]   Testosterone suppression in opioid users: A systematic review and meta-analysis [J].
Bawor, Monica ;
Bami, Herman ;
Dennis, Brittany B. ;
Plater, Carolyn ;
Worster, Andrew ;
Varenbut, Michael ;
Daiter, Jeff ;
Marsh, David C. ;
Steiner, Meir ;
Anglin, Rebecca ;
Coote, Margaret ;
Pare, Guillaume ;
Thabane, Lehana ;
Samaan, Zainab .
DRUG AND ALCOHOL DEPENDENCE, 2015, 149 :1-9
[6]   Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline [J].
Bhasin, Shalender ;
Cunningham, Glenn R. ;
Hayes, Frances J. ;
Matsumoto, Alvin M. ;
Snyder, Peter J. ;
Swerdloff, Ronald S. ;
Montori, Victor M. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2010, 95 (06) :2536-2559
[7]   Testosterone Replacement Therapy in Men With Hypogonadism and HIV/AIDS: Results From the TRiUS Registry [J].
Blick, Gary ;
Khera, Mohit ;
Bhattacharya, Rajib K. ;
Kushner, Harvey ;
Miner, Martin M. .
POSTGRADUATE MEDICINE, 2013, 125 (02) :19-29
[8]   Testosterone Replacement Therapy Outcomes Among Opioid Users: The Testim Registry in the United States (TRiUS) [J].
Blick, Gary ;
Khera, Mohit ;
Bhattacharya, Rajib K. ;
Dat Nguyen ;
Kushner, Harvey ;
Miner, Martin M. .
PAIN MEDICINE, 2012, 13 (05) :688-698
[9]   The Effect of Diurnal Variation on Clinical Measurement of Serum Testosterone and Other Sex Hormone Levels in Men [J].
Brambilla, Donald J. ;
Matsumoto, Alvin M. ;
Araujo, Andre B. ;
McKinlay, John B. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2009, 94 (03) :907-913
[10]   Effects of aromatase inhibition in hypogonadal older men: a randomized, double-blind, placebo-controlled trial [J].
Burnett-Bowie, Sherri-Ann M. ;
Roupenian, Kristen C. ;
Dere, Melissa E. ;
Lee, Hang ;
Leder, Benjamin Z. .
CLINICAL ENDOCRINOLOGY, 2009, 70 (01) :116-123