Knowing when to commence with testosterone replacement therapy in men can be difficult. This article provides a number of tips and hints that aim to make the process easier for primary care professionals
Male testosterone deficiency (TD) is a relatively common condition that affects approximately 9% of middle-aged men.1 Among its more recognised symptoms, such as decreased libido, fatigue, and loss of muscle mass, TD is associated with the development of obesity, metabolic syndrome, osteoporosis, and cognitive decline.2 Furthermore, Diabetes UK estimates that approximately 25% of all male patients with type 2 diabetes have lower than normal levels of testosterone.3
Despite its increasing prevalence and ease of diagnosis, TD remains largely under-investigated and untreated in primary care, possibly due to a misunderstanding of the condition and a misperception of its influence on male health. But, as the prevalence of TD continues to rise, it is important that in primary care we consider the impact of this condition on men’s health and treat it appropriately.
To clarify some of the uncertainties associated with male TD, this article offers 10 tips for making an assessment of TD and providing treatment.
Despite its increasing prevalence and ease of diagnosis, TD remains largely under-investigated and untreated in primary care
The goal of TRT is to return a patient’s serum testosterone level to the upper limit of the normal range, ideally above 15nmol/L
The fundamental principle of testosterone replacement therapy is to return patients’ testosterone from sub-optimal levels to normal physiological levels. Most of the common misconceptions about TRT derive from its association with the effects of supra-physiological doses of the drug and its potential complications, which can be minimised by regular monitoring.
As we live longer, and the numbers of patients with obesity, type 2 diabetes, and other testosterone suppressing conditions, including chronic disease and the use of various medications, increase, it may be time to stop thinking of testosterone deficiency as a normal consequence of ageing in males. Only when we begin to treat TRT as more than a lifestyle drug will we make significant gains in improving the quality of life and mortality for men with this condition.
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