The American Urological Union (AUA) is a professional urologic organization. Founded in 1902, the Agency now has over 21,000 members. One of its many roles is to provide guidelines for various aspects of urological health so that doctors can better serve their patients.
In April 2018, AUA issued a new clinical guideline for the diagnosis and treatment of testosterone deficiency. Includes 31 recommendations. We will decompress some of the most important points here today.
What is testosterone deficiency?
You have probably heard of testosterone in the light of men’s sexual health. It is produced by the testicles, this hormone leads to libido, gives men their physical characteristics (such as facial hair) and helps maintain muscle mass.
Some bodies of men do not make enough testosterone. This condition, called hypogonadism, can occur when there are problems with the testicles or the part of the brain that activates testosterone production. Hypogonadism can also be the result of chemotherapy, radiotherapy, inflammation, infection and obesity. (Learn more about the causes of low testosterone here.)
In addition, men’s bodies make less testosterone as they grow older. In fact, testosterone levels decrease from 1% to 3% each year after a man’s 400th birthday. As a result, some – but not all – men begin to have symptoms such as low sexual movement, fatigue, mood, erectile dysfunction (ED) and reduced muscle mass.
How is testosterone deficiency diagnosed?
According to the new AUA guideline, there must be two criteria to diagnose a man with testosterone deficiency:
- Its testosterone levels should be below 300 ng/dl. Two total testosterone measurements taken in two different cases are recommended. Because men’s testosterone levels range throughout the day, the measurements early in the morning are the rule.
- Man should have low testosterone symptoms, such as those mentioned above – low libido, low energy, depression, ed.
If a person meets only one of these criteria, then he has no testosterone deficiency.
What is testosterone replacement treatment (TRT)?
Testosterone replacement therapy (TRT) is prescribed in some men with testosterone deficiency. This synthetic form of testosterone is usually administered through gels, balls or injections.
What does AUA suggest?
Some of the recommendations defined by AUA include the following:
- Clinicians should inform patients with a lack of testosterone that low testosterone is a risk factor for cardiovascular disease. Note: In 2015, the US Food and Drug Administration (FDA) issued counseling, expressing concerns that men who take testosterone may be at a higher risk of heart attack and stroke. (Read more here.) However, the link with such events was considered controversial.
- Clinicians should inform patients of the absence of elements that link testosterone therapy to the development of prostate cancer. Note: There were concerns that testosterone therapy can lead to prostate cancer, but this joint has not been proven. However, testosterone can feed the growth of existing prostate cancer cells, so TRT is not usually recommended for men with prostate cancer.
- The long -term impact of exogenous testosterone on spermatogenesis should be discussed with patients interested in future fertility. Exogenous testosterone treatment should not be prescribed to men who are currently trying to conceive. Note: Testosterone is important for the production of sperm, but the synthetic form used in TRT can interfere with this process. Sometimes, sperm measurements increase as men stop the TRT, but this cannot be guaranteed. Men can decide to pull their sperm before they start treatment.
- Clinicians should discuss the risk of transportation with patients using testosterone gels/creams. Men are advised to wash their hands thoroughly after applying testosterone to the skin to avoid transport to another person. They should also cover the application area before sex. (For example, if testosterone is applied to the shoulder, a t -shirt can reduce the risk of transporting the gel or cream to a partner.)
- Testosterone levels should be measured every 6-12 months while in the treatment of testosterone. Note: While in TRT, it is important for men to see their doctor regularly for attestation, so that testosterone levels can be evaluated and treatment can be adjusted if necessary.
Is TRT suitable for you?
As mentioned above, our discussion here covers only a few of AUA’s recommendations. The guideline itself, along with a complete assessment of your overall health, can help your doctor to decide if the TRT is right for you.
Resources
American Urological Union
“AUA releases a new clinical guideline to diagnose and treat testosterone deficiency”
(Press Release. April 10, 2018)
“Assessment and Management of testosterone deficiency”
(Posted 2018)
International Society for Sexual Medicine
“Can testosterone replacement therapy (TRT) make a person sterile?”
“What are some of the side effects and dangers of testosterone treatment?”
Mpr
“Aua: New Guidelines for Diagnosis.
(April 10, 2018)
Sexhealthmatters.org
“What causes low testosterone?”
(November 2, 2015)
