Treatment for Andropause (Late-Onset Hypogonadism)

Diagnosis and Assessment

The European Association of Urology recommends that diagnosis of hypogonadism should only be made in men with consistent symptoms and unequivocally low serum testosterone levels 2
The diagnosis requires morning total testosterone measurements on at least two separate occasions, as recommended by the European Urology guidelines 1
Clinical evaluation should include assessment of symptoms such as decreased libido, erectile dysfunction, fatigue, and decreased vitality, as suggested by the New England Journal of Medicine 3
Evaluation for potential causes, including pituitary disorders and medications affecting the HPG axis, is necessary, according to the European Urology guidelines 1
Physical examination, including BMI and waist circumference, is an essential part of the clinical evaluation, as recommended by the European Urology guidelines 1

The European Urology guidelines recommend weight loss through low-calorie diets to reverse obesity-associated secondary hypogonadism 1
Physical activity shows benefits, with results correlating to exercise duration and weight loss, as suggested by the European Urology guidelines 1
These interventions may increase testosterone levels by 1-2 nmol/L, according to the European Urology guidelines 1
Testosterone replacement therapy is indicated for men with symptomatic hypogonadism, consistently low testosterone levels, and symptoms affecting quality of life, as recommended by the Annals of Internal Medicine 2

Absolute contraindications to testosterone therapy include active or treated male breast cancer, as recommended by the European Urology guidelines 1
Planning fertility in the near term is also a contraindication, according to the European Urology guidelines 1

Regular follow-up with a standardized monitoring plan, including evaluation of symptoms, adverse effects, and compliance, is necessary, as suggested by the New England Journal of Medicine 3

Benefits of testosterone therapy include improved sexual functioning and quality of life, with small but significant improvements, as reported by the Annals of Internal Medicine 2, 4
Increased muscle mass and strength are also benefits of testosterone therapy, according to the New England Journal of Medicine 3
Improved bone mineral density is another benefit, as suggested by the New England Journal of Medicine 3
However, there is limited or no benefit for physical functioning, depressive symptoms, energy and vitality, cognition, weight reduction, or cardiometabolic status, as reported by the Annals of Internal Medicine 2, 4 and the European Urology guidelines 1

Testosterone therapy should not be used in eugonadal men, as recommended by the European Urology guidelines 1
Fertility concerns must be addressed before initiating therapy, according to the European Urology guidelines 1
Long-term efficacy and safety data are limited, particularly for cardiovascular outcomes and prostate cancer risk, as reported by the Annals of Internal Medicine 2, 4
Combining lifestyle modifications with TRT may yield better outcomes in symptomatic patients, as suggested by the European Urology guidelines 1