Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, and EAU Recommendations

    May 2005 in “ Andrology ”
    Eberhard Nieschlag, Ronald S. Swerdloff, Hermann M. Behre, L.J.G. Gooren, Jean‐Marc Kaufman, Jean‐Jacques Legros, Bruno Lunenfeld, John E. Morley, Claude Schulman, Chunlei Wang, W. Weidner, Frederick C. W. Wu
    TLDR Testosterone treatment for older men can have short-term benefits, but long-term risks are unclear, requiring careful evaluation and monitoring.
    The document provided recommendations for the investigation, treatment, and monitoring of late-onset hypogonadism (LOH) in males, highlighting the clinical and biochemical syndrome associated with aging and characterized by low testosterone levels. It emphasized the need for a thorough physical and biochemical work-up to diagnose LOH, including measuring serum testosterone and sex hormone binding globulin. Testosterone therapy was recommended only when there was clear clinical and biochemical evidence of deficiency, with contraindications including prostate or breast cancer. The document advised using natural testosterone preparations and avoiding alkylated androgens due to liver toxicity. Regular monitoring of prostate health, mood, behavior, and bone density was recommended during treatment. The recommendations also addressed the potential need for additional treatments, such as phosphodiesterase 5-inhibitors for erectile dysfunction, and highlighted the importance of careful consideration in men treated for prostate cancer.
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