Journal of Andrology
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Journal of Andrology, Vol. 27, No. 2, March/April 2006
Copyright © American Society of Andrology
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Preface

Androgen Replacement Overview and Current Guidelines

PETER N. SCHLEGEL, CO-EDITOR-IN-CHIEF AND MATTHEW P. HARDY, CO-EDITOR-IN-CHIEF


Within this Journal, multiple articles overview the phenomenon of low androgen levels in aging men. International Society of Andrology (ISA), International Society for the Study of the Aging Male (ISSAM), and European Association of Urology (EAU) recommendations for management of "Late Onset Hypogonadism in Males," the American Society of Andrology position statement on "Testosterone Replacement Therapy for Aging Men," and a review article summarizing some of the data on these subjects are all presented. Given the dearth of definitive data and the limited outcome studies that are currently available, few absolute conclusions can be drawn. However, low testosterone, typically defined as below 250 ng/dL, may be associated with substantive symptoms, and selected patients are helped by testosterone replacement therapy. What is not addressed in these articles is the knowledge that testosterone therapy is very commonly applied in clinical practice and is probably requested even more frequently than it is prescribed. The potential for abuse or complications from treatment probably exists. Several points are commonly agreed upon. The association of low testosterone with symptoms in older men is agreed upon as an appropriate situation where replacement therapy should be considered. Monitoring of patients on treatment is necessary. The indications for treatment should be better defined based on larger studies documenting the outcomes of treatment. Indeed, the Institute of Medicine, in a report issued in 2003 (published as Testosterone and Aging: Clinical Research Directions, 2004, C.T. Liverman and D.G. Blazer, eds, Natl Acad Press, Washington, DC, 240 p), has mandated the initiation of a large-scale trial to determine risks and effectiveness of treatment, with the chief concern being to address whether long-term testosterone therapy might increase the risk of prostate cancer. As with many clinical conditions where data are incomplete, testosterone therapy for aging men remains an area that is still evolving in terms of indications, treatment approach, and expected results.





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