FINAL-Androgens-in-Men-Standalone

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Table of Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Summary of Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Method of Development of Evidence-Based Clinical Practice Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Diagnosis of Hypogonadism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Treatment of Androgen Deficiency With Testosterone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Order Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Reprint Information, Questions & Correspondences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Inside Back Cover
Abstract Objective: To update the guidelines for the evaluation and treatment of androgen deficiency syndromes in adult men published previously in 2006. Participants: The Androgens in Men Guideline Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. Consensus Process: Consensus of this guideline was guided by systematic reviews of evidence and discussions during in-person group meetings, several conference calls, and e-mail communications. The drafts prepared by the Task Force were reviewed successively by The Endocrine Society’s Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and approved by Council. At each stage of review, the Task Force received written comments and incorporated needed changes. Task Force members had final responsibility for and control over content presented in this guideline. Conclusions: We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels. We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test. We recommend confirmation of the diagnosis by repeating the measurement of morning total testosterone and in some men in whom total testosterone is near the lower limit of normal or in whom sex hormone binding globulin (SHBG) abnormality is suspected by measurement of free or bioavailable testosterone level, using validated assays. We recommend testosterone therapy for men with symptomatic androgen deficiency to induce and maintain secondary sex characteristics and to improve their sexual function, sense of well-being, muscle mass and strength, and bone mineral density. We recommend against starting testosterone therapy in patients with breast or prostate cancer, a palpable prostate nodule or induration or prostate-specific antigen greater than 4 ng/ml or greater than 3 ng/ml in men at high risk for prostate cancer such as African Americans or men with first-degree relatives with prostate cancer without further urological evaluation, hematocrit >50%, untreated severe obstructive sleep apnea, severe lower urinary tract symptoms with International Prostate Symptom Score (IPSS) > 19, or uncontrolled or poorly controlled heart failure. When testosterone therapy is instituted, we suggest aiming at achieving testosterone levels during treatment in the mid-normal range with any of the approved formulations, chosen on the basis of the patient’s preference, consideration of pharmacokinetics, treatment burden, and cost. Men receiving testosterone therapy should be monitored using a standardized plan. J Clin Endocrinol Metab, June 2010, 95(6):2536–2559 T e s t o s t e r o n e T h e r a p y i n M e n w i t h A n d r o g e n D e f i c i e n c y S y n d r o m e s 3
Page 1 and 2: T h e E n d o c r i n e S o c i e t
Page 3: T h e E n d o c r i n e S o c i e t
Page 7 and 8: We recommend against testosterone t
Page 9 and 10: 1.0. DIAGNOSIS OF HYPOGONADISM Defi
Page 11 and 12: measurement for the diagnosis of an
Page 13 and 14: FIG. 1. An approach for the diagnos
Page 15 and 16: it. no clinical trials have assesse
Page 17 and 18: men with obesity (65, 66) or type 2
Page 19 and 20: Most studies of testosterone therap
Page 21 and 22: TABLE 7. Some recommended regimens*
Page 23 and 24: of subjects experienced an improvem
Page 25 and 26: Adverse outcomes associated with te
Page 27 and 28: References 1. Atkins D, Best D, Bri
Page 29 and 30: 55. Brodsky IG, Balagopal P, Nair K
Page 31 and 32: 105. Bretton PR 1994 Prostate-speci
Page 33 and 34: Acknowledgments The members of the
Page 35 and 36: Commercial Reprint Information For

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