Oral Presentation Annual Meetings of the Endocrine Society of Australia and Society for Reproductive Biology and Australia and New Zealand Bone and Mineral Society 2016

Position Statement on the assessment and management of male hypogonadism: the Endocrine Society of Australia (#67)

Bu Yeap 1 2 , Mathis Grossmann 3 , Rob McLachlan 4 , David Handelsman 5 6 , Gary Wittert 7 , Ann J Conway 5 6 , Bronwyn Stuckey 1 8 9 , Douglas Lording 10 , Carolyn Allan 4 , Jeffrey Zajac 3 , Henry Burger 4
  1. School of Medicine, University of Western Australia, Perth, WA, Australia
  2. Department of Endocrinology and Diabetes, Fremantle and Fiona Stanley Hospitals, Perth, WA, Australia
  3. Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria
  4. Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
  5. ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
  6. Andrology Department, Concord Hospital, Sydney, New South Wales
  7. Discipline of Medicine, University of Adelaide, Adelaide, South Australia
  8. Keogh Institute for Medical Research, Perth, Australia
  9. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia
  10. Cabrini Hospital, Melbourne, Victoria

The Endocrine Society of Australia formulated guidelines for testosterone prescribing in 2000. Since then prescriptions of testosterone have risen dramatically without any new proven indications. Controversy has arisen over the role of testosterone in older men with medical comorbidities, who have low circulating testosterone in the absence of hypothalamic, pituitary or testicular disease. There are gaps in the evidence base in relation to the potential benefits of testosterone treatment in men with obesity, type 2 diabetes, and receiving long term glucocorticoid or opioid therapy, and ongoing debate over risk of cardiovascular adverse events. The Australian Government in 2015 tightened the criteria by which testosterone therapy would be subsidised in the absence of pathological hypogonadism. In view of these developments, the ESA commissioned a Position Statement to update its guidelines and to inform the management of men with androgen deficiency. Key elements are as follows: Testosterone replacement therapy is warranted in men with pathological hypogonadism, without regard to age. There is inadequate evidence to justify testosterone treatment in older men, usually with chronic disease who have low circulating testosterone but without hypothalamic, pituitary or testicular pathology. Additional studies are needed in men with obesity, metabolic syndrome and type 2 diabetes. Men on longer term glucocorticoid and opioid therapy may benefit from endocrine review. Testosterone is the native hormone that should be replaced, with monitoring of therapy for efficacy and safety. Treatment aims to relieve an individual’s symptoms and signs of androgen deficiency by administration of standard doses and maintaining circulating testosterone within the reference eugonadal range. Evaluation for cardiovascular disease and prostate cancer risks should be as appropriate for eugonadal men of similar age. When there is a reasonable possibility of pre-existing prostate disease, prostate examination and PSA testing should be performed before commencing treatment.