The journal Maturitas has announced the publication of a position statement by the European Menopause and Andropause Society (EMAS) covering testosterone replacement therapy in the aging male.
Late-onset hypogonadism (LOH) represents a common clinical entity in older men. It is characterized by the presence of symptoms (most usually of a sexual nature, such as decreased libido, decreased spontaneous erections and erectile dysfunction) in combination with low serum testosterone concentrations. Whether testosterone replacement therapy (TRT) should be offered to those individuals is still under extensive debate because of the uncertainties regarding risk of cardiovascular disease and prostate cancer. The position statement provides a practical guide to the use of testosterone replacement in older men.
The overall conclusion is that a general policy around offering TRT to all aging men with low testosterone concentrations is not recommended. It is always advisable to encourage older men with LOH to undertake lifestyle modifications, including weight loss, increasing exercise, stopping smoking and reducing alcohol intake before considering starting TRT. The assessment procedure should include individual evaluation of co-morbidities and careful risk versus benefit estimation; TRT should be very carefully weighed up in testosterone deficient older men with or without pre-existing heart disease, until evidence from large randomized prospective trials regarding cardiovascular safety becomes available.
Older men should be able to discuss testosterone replacement therapy with their health professional so that shared and informed decisions can be made.
These and other recommendations presented in EMAS’ position statement are published in the article ‘EMAS position statement: Testosterone replacement therapy in the aging male’? in Maturitas published by Elsevier.