Testosterone therapy and mortality in US veterans

Recommendations on the diagnosis, treatment and monitoring of testosterone deficiency in men

The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age globally. One in four persons living in Europe and Northern America will be aged 65 or over. One of the goals of ISSAM is to raise awareness of the special health needs of older men. Since a significant number of aging men will eventually become testosterone deficient, the Hypogonadism panel of ISSAM updates its guidelines.

Testosterone and Cardiovascular Health: Safety of Treatment of Hypogonadism

INTRODUCTION

Controversy has arisen over the issue of the cardiovascular safety of testosterone.

AIM

The aim of this article is to examine the evidence as to the cardiovascular safety involved with the administration of testosterone.

METHODS

A literature review was performed with regard to cardiovascular safety of testosterone.

MAIN OUTCOME MEASURE

The main outcome measure was to evaluate the available evidence as to cardiovascular safety and risk of testosterone.

RESULTS

A handful of recently published and widely discussed manuscripts have suggested that administration of testosterone replacement therapy increases the frequency of adverse cardiovascular events. In contrast, there have been recent clinical reports suggesting that testosterone is either safe or actually reduces cardiovascular events and mortality. All of these studies-both those suggesting that testosterone has adverse effects, as well as those suggesting it has positive effects on the cardiovascular system-have limitations.

CONCLUSION

What is missing is a large, long-term, prospective, placebo controlled, double blind trial in which hypogonadal men receive either testosterone or placebo, testosterone levels are carefully monitored, and the primary outcomes are well-defined major adverse cardiovascular/cerebrovascular events. Kloner RA. Testosterone and cardiovascular health: Safety of treatment of hypogonadism. Sex Med Rev 2015;3:56-62.

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter syndrome, Kallmann syndrome, pituitary or testicular disorders, as well as in men with idiopathic, metabolic or iatrogenic conditions that result in testosterone deficiency. These recommendations do not encompass the full range of pathologies leading to hypogonadism (testosterone deficiency), but instead focus on the clinical spectrum of hypogonadism related to metabolic and idiopathic disorders that contribute to the majority of cases that occur in adult men.

Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men - a suggested update

Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in men were first published by ISSAM in 2002 In 2005, and, in 2008, updated recommendations were published in the International Journal of Andrology, the Journal of Andrology, the Aging Male and European Urology. Towards discussions at the next ISSAM/ESSAM meeting in Moscow, 29 November 2013, we suggest the following update.