International Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


July 10, 2018

In This Article

Testosterone Deficiency

British Society for Sexual Medicine

Screen all men presenting with erectile dysfunction (ED), loss of spontaneous erections, or low sexual desire.

Screen for TD in all men with type 2 diabetes mellitus, BMI >30 kg/m2, or waist circumference >102 cm.

Screen for TD in all men on long-term opiate, antipsychotic, or anticonvulsant medication.

Restrict diagnosis of TD to men with persistent symptoms suggesting TD and confirmed low T.

Measure fasting T levels in the morning before 11 AM, acknowledging that, in normal life, nonfasting levels could be up to 30% lower.

Repeat total testosterone (TT) assessment on ≥2 occasions by a reliable method; in addition, measure free testosterone (FT) in men with levels close to the lower normal range (8-12 nmol/L) or those with suspected or known abnormal sex hormone binding globulin (SHBG) levels.

Measure luteinizing hormone (LH) serum levels to differentiate primary from secondary TD.

Perform cardiovascular, prostate, breast, and hematologic assessments before start of treatment.

Offer T therapy to symptomatic men with TD syndrome for treated localized low-risk prostate cancer (Gleason score <8, stages 1-2, preoperative PSA level <10 ng/mL, and not starting before 1 year of follow-up) and without evidence of active disease (based on measurable PSA level, DRE result, and evidence of metastatic disease).

Assess response to therapy at 3, 6, and 12 months and every 12 months thereafter.

Aim for a target TT level of 15-30 nmol/L to achieve optimal response.

Assess prostate health by PSA and DRE before commencing testosterone replacement therapy followed by PSA at 3-6 months, 12 months, and every 12 months thereafter.



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