The Optimal Indication for Testosterone Replacement Therapy in Late-Onset Hypogonadism

The document from 2019 reviewed the use of testosterone replacement therapy (TRT) for late-onset hypogonadism (LOH), highlighting the need for evidence-based guidelines for its optimal indication. It found that a significant number of men (up to 25%) were receiving TRT without prior testosterone level testing. The diagnosis of LOH should include both characteristic signs and symptoms and decreased serum total testosterone (TT) levels, with recent guidelines suggesting a TT threshold of 250–350 ng/dL. The document emphasized the importance of distinguishing between different forms of hypogonadism, using questionnaires for symptom assessment, and conducting a thorough physical and biochemical work-up. Morning measurements for TT and free testosterone (FT) levels were recommended, along with considering individual variations in testosterone sensitivity. Proper diagnosis and indication for TRT are crucial, and TRT may be appropriate for men with LOH who have no contraindications.