Testosterone Deficiency / Hypogonadism
Summary
Urological referral/ Endocrinologist referral
Advice: Can be managed in general practice. Occasionally prostate cancer needs to be excluded. Nick Brook is always happy to see your patient for advice.
Refer To: Urologist or Endocrinologist
Diagnosis
Referral is indicated in men who have symptoms & signs of hypogonadism, with low serum testosterone levels. Diagnosis should be confirmed by two measurements of morning total and free testosterone levels, and serum hormone binding globulin (SHBG), with blood taken as close as possible to 8am for day shift workers.
Indications for treatment
Testosterone replacement therapy should be instigated only:
- to improve sexual function & libido (although it may not help in some)
- to improve general malaise
- to increase muscle mass & muscle strength
- to increase bone mineral density
Contra-indications to treatment
Testosterone replacement therapy should not be started in men with:
- breast or prostate cancer
- a palpable prostatic nodule or induration
- PSA greater than 3 ng/ml (requires urological evaluation)
- erythrocytosis (PCV greater than 50%)
- hyperviscosity
- untreated obstructive sleep apnoea
- severe lower urinary tract symptoms (although recent evidence suggests this may not be an exlusion)
- class III or IV heart failure
Follow-up
The aim should be to achieve testosterone levels in the mid-normal range using gel formulations.
