Testosterone Therapy in Muscular Dystrophy Patients

Diagnostic Approach for Testosterone Deficiency

• Testosterone deficiency should be properly diagnosed through laboratory testing before considering treatment 1
• Diagnosis requires both low testosterone measurements and presence of symptoms/signs 2
• Total testosterone level below 300 ng/dL on at least two early morning measurements is considered the threshold for low testosterone 2
• Luteinizing hormone (LH) levels should be measured to help establish the etiology of testosterone deficiency 2

Treatment Considerations

• If testosterone deficiency is confirmed, treatment should aim to achieve total testosterone levels in the middle tertile of the normal reference range (450-600 ng/dL) 1
• Commercially manufactured testosterone products should be prescribed rather than compounded testosterone 3
• Alkylated oral testosterone should not be prescribed due to risk of liver toxicity 1

Risks and Monitoring

• Testosterone therapy should not be commenced for 3-6 months in patients with a history of cardiovascular events 1
• Testosterone therapy has inhibitory effects on spermatogenesis and should not be prescribed to men trying to conceive 1
• Regular monitoring of testosterone levels, hematocrit, and liver function is necessary during treatment 1

Conclusion for Clinical Practice

• Hematologists/oncologists should refer patients with muscular dystrophy and suspected testosterone deficiency to appropriate specialists (endocrinology or urology) for evaluation 2
• The primary goal of testosterone therapy should be to address specific symptoms of hypogonadism rather than to treat the underlying muscular dystrophy 1