Testosterone Replacement Therapy for Male Aging: ASA Position Statement

The American Society of Andrology suggests that testosterone replacement therapy in aging men is indicated when both clinical symptoms and signs suggestive of androgen deficiency and decreased testosterone levels are present.Testosterone replacement may also be warranted in older men with markedly decreased testosterone levels regardless of symptoms, but signs of androgen deficiency should be present.Based on the data currently available, the measurement of total blood testosterone is the most appropriate and widely available test to confirm hypogonadism.Subject to future research, a total testosterone level of 300 ng/dL measured in the morning, using a reliable assay, may be used as a threshold below which an individual can be considered hypogonadal.The American Society of Andrology recommends periodic monitoring of men receiving testosterone replacement therapy.Subject to individual clinical response, evaluation is recommended at 3 to 6 months after initiation of therapy, and then yearly.A physical examination, including digital rectal examination of the prostate, a prostate-related symptom assessment, prostate-specific antigen (PSA) level, and hematocrit, should be performed at 3, 6, and 12 months, and then annually.Testosterone therapy should be altered or ended if the hematocrit exceeds 52%.Contraindications to therapy include a history of prostate cancer, breast cancer, untreated sleep apnea, and untreated and/or severe congestive heart failure.