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2015 ; 17
(2
): 177-86
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Diagnosis and management of testosterone deficiency
#MMPMID25532575
McBride JA
; Carson CC
; Coward RM
Asian J Androl
2015[Mar]; 17
(2
): 177-86
PMID25532575
show ga
Testosterone supplementation therapy (TST) use has dramatically increased over
the past decade, due to the availability of newer agents, aggressive marketing,
and an increasing incidence of testosterone deficiency (TD). Despite the increase
in TST, a degree of ambiguity remains as to the exact diagnostic criteria of TD,
and administration and monitoring of TST. One explanation for this phenomenon is
the complex role testosterone plays in multiple physiologic pathways. Numerous
medical co-morbidities and medications can alter testosterone levels resulting in
a wide range of nonspecific clinical signs and symptoms of TD. The diagnosis is
also challenging due to the lack of a definitive serum total testosterone level
that reliably correlates with symptoms. This observation is particularly true in
the aging male and is exacerbated by inconsistencies between different laboratory
assays. Several prominent medical societies have developed guideline statements
to clarify the diagnosis, but they differ from each other and with expert opinion
in several ways. Aside from diagnostic dilemmas, there are numerous subtle
advantages and disadvantages of the various testosterone agents to appreciate.
The available TST agents have changed significantly over the past decade similar
to the trends in the diagnosis of TD. Therefore, as the usage of TST increases,
clinicians will be challenged to maintain an up-to-date understanding of TD and
TST. The purpose of this review is to provide a clear description of the current
strategies for diagnosis and management of TD.