DRE = digital rectal exam; PSA = prostatic specific antigen. To diagnose a patient as hypogonadal, the Endocrine Society recommends measuring serum testosterone twice. This double measurement is recommended because a significant percentage of men with an initial level of testosterone in the slightly hypogonadal range claim to have a normal testosterone level when the measurement is repeated. 26 Our study showed that 82.0% of men did not undergo two serum testosterone tests and 24.6% did not have a single serum testosterone test before starting treatment.
Similarly, no serum testosterone test was observed in 48.0% of men in the 12 months following the start of treatment. Testosterone should be tested three months after starting ADT and in case of any increase in PSA levels. The fortuitous discovery of a moderate elevation of total testosterone in the context of research for hypogonadism does not necessarily justify research. In women, testosterone is produced by the ovaries and adrenal glands, and by the conversion of proandrogens in peripheral tissues.
Typical side effects related to estrogen and testosterone preparations are alopecia, acne and hirsutism, although they depend on dosage and duration and are not common. Testosterone is primarily used to treat symptoms of sexual dysfunction in men and women and hot flashes in women. In the present study, 25% of the entire study cohort had complete laboratory values for testosterone and 17% had complete laboratory data for PSA. Association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.
Side effects in women include acne, hepatotoxicity and virilization and usually only occur when testosterone is used in supraphysiological doses. The Food and Drug Administration warns that testosterone therapy may increase the risk of cardiovascular complications. Meanwhile, doctors must inform patients that the cardiovascular risks and benefits of testosterone therapy are uncertain and should be involved in shared decision-making. While no data is available on long-term outcomes, testosterone prescriptions are becoming more common.
Although specific research is beyond the scope of this protocol, it is important to establish the etiology of hypogonadism, after biochemical confirmation of the clinical diagnosis and before starting testosterone replacement therapy. Patients should use the same laboratory for initial and follow-up testing of testosterone because the reference ranges depend on the laboratory2, meaning that results from different laboratories may not be comparable. Effects of transdermal testosterone on bones and muscles in older men with low levels of bioavailable, low testosterone bone mass and physical frailty.
