EMAS position statement: Testosterone replacement therapy in the aging male‏

• Late-onset hypogonadism (LOH) represents a common clinical entity among aging males.
• Typical sexual symptoms suggestive of androgen deficiency comprise loss of libido, decreased spontaneous erections and erectile dysfunction.
• Testosterone replacement therapy (TRT) should be offered to these individuals, only if a combination of testosterone deficiency symptoms and low testosterone is present.
• Management of aging men with LOH should include individual evaluation of co-morbidities and careful risk—benefit assessment.
• Evidence from large randomized prospective trials regarding beneficial effects and cardiovascular safety of testosterone replacement therapy is needed.

IntroductionLate-onset hypogonadism (LOH) represents a common clinical entity in aging males, characterized by the presence of symptoms (most usually of a sexual nature, such as decreased libido, decreased spontaneous erections and erectile dysfunction) and signs, in combination with low serum testosterone concentrations. Whether testosterone replacement therapy (TRT) should be offered to those individuals is still under extensive debate.AimsThe aim of this position statement is to provide and critically appraise evidence on TRT in the aging male, focusing on pathophysiology and characteristics of LOH, indications for TRT, available therapeutic agents, monitoring and treatment-associated risks.Materials and methodsLiterature review and consensus of expert opinion.Results and conclusionsDiagnosis and treatment of LOH is justified, if a combination of symptoms of testosterone deficiency and low testosterone is present. Patients receiving TRT could profit with regard to obesity, metabolic syndrome, type 2 diabetes mellitus, sexual function and osteoporosis and should undergo scheduled testing for adverse events regularly. Potential adverse effects of TRT on cardiovascular disease, prostate cancer and sleep apnea are as yet unclear and remain to be investigated in large-scale prospective studies. Management of aging men with LOH should include individual evaluation of co-morbidities and careful risk versus benefit assessment.