Testosterone Deficiency: A Common, Unrecognised Syndrome?

ContextTestosterone deficiency syndrome (TDS) is highly prevalent in ageing men. Associated symptoms may significantly impair quality of life and may affect the function of multiple organ systems. In addition, TDS may have an impact on life expectancy. Although still the subject of debate, testosterone administration may hold promise in symptomatic hypogonadal men.ObjectiveTo present an overview of current data on TDS and treatment of hypogonadal patients with testosterone.Evidence acquisitionThis manuscript is based on presentations given at a satellite symposium on TDS held at the 2nd World Congress on Controversies in Urology (CURy) in Lisbon, Portugal. Data were retrieved from recent review papers and original papers on TDS, metabolic syndrome, and erectile dysfunction (ED).Evidence synthesisPreliminary data of the Transversal European Survey on Testosterone deficiency Diagnosis (TESTo-Dia) demonstrated that physicians need more information and education on TDS. Although there is no clear-cut testosterone threshold at which overall symptoms appear, testosterone deficiency can be associated with severe symptoms and conditions such as cardiovascular disease, diabetes, metabolic syndrome, and ED. Consequently, appropriate treatment of hypogonadal men is highly warranted. There are compelling data showing that testosterone administration does not increase the risk of prostate cancer. Moreover, treatment of testosterone deficiency appears to have a neuroprotective role. Based on these data, physicians may not withhold testosterone treatment from hypogonadal patients. Current treatment options include testosterone administration via gels, patches, capsules, or implants. A new transdermal-matrix patch appears to be safe and effective in hypogonadal men.ConclusionsAlthough long-term randomised controlled trials are needed, treatment with testosterone in selected symptomatic hypogonadal men may have a beneficial effect on symptoms and/or prevention of several age-related disorders.