(413) Framework for Testosterone Therapy in Hypogonadal Men with a History of Prostate Cancer: A Consensus Statement for Sexual Medicine

Introduction Background: Studies have found that the prevalence of low testosterone is significantly higher in men with prostate cancer (around 30%) compared to men with benign prostatic hyperplasia (10%). Low testosterone levels are associated with a higher probability of finding advanced-stage prostate cancer. Available literature provides evidence for the safe application of Testosterone Therapy (TTh) in patients previously treated for prostate cancer with either radical prostatectomy or radiotherapy. Furthermore, there exists evidence that severely hypogonadal levels of testosterone may lead to worse oncological and cardiometabolic outcomes. Treatments like chemotherapy can also sometimes reduce testosterone production, though this is usually temporary. In addition, concomitant conditions such as obesity or diabetes can also influence testosterone levels in these patients. The use of testosterone replacement therapy (TRT) in men with a history of prostate cancer has long been considered controversial. However, growing evidence suggests that, in appropriately selected patients, TRT can be both safe and effective. Despite this, many clinicians remain uncertain about when and how to initiate therapy in this complex group.The group enrolled experts to review the evidence and provide a consensus statement with the aim of supporting clinicians by providing practical, evidence-informed guidance for clinical use. Objective To provide clinicians with a structured, pragmatic framework for evaluating, initiating, and monitoring Testosterone Replacement Therapy in men previously treated for prostate cancer, based on an expert consensus. Methods A multidisciplinary panel reviewed the existing literature, including randomised trials, retrospective studies, meta-analyses, and international guidelines, and combined this with clinical expertise to develop a set of expert consensus-based recommendations. The emphasis here is on practical and safe applicability in routine clinical settings. Results The consensus outlines a stepwise clinical approach to TRT, including timing of initiation, cancer risk stratification, Multidisciplinary Team (MDT) review, and baseline and follow-up investigations. TRT is considered appropriate for men with stable low- to intermediate-risk disease who are experiencing significant symptoms of testosterone deficiency. Monitoring protocols include regular PSA, haematocrit, and symptom reassessment. Practical guidance is also included on navigating borderline or high-risk cases, shared care with primary providers, and when to pause or discontinue therapy. While long-term data in high-risk groups remain limited, emerging studies suggest that with careful selection and oversight TRT may be safe even in more complex cases. Conclusions This consensus provides a practical and implementable pathway for clinicians managing hypogonadism in men with a history of prostate cancer. The recommendations are designed to support decision making in everyday practice, reduce unwarranted variation in care, and improve quality of life for affected men. As evidence evolves, structured consensus documents like this one will help clinicians navigate uncertainty with greater confidence Disclosure No