Medical Indications for Testosterone Replacement Therapy
Testosterone plays an important role in health and disease, affecting energy and libido, erectile dysfunction, cardiovascular disease, metabolic syndrome, diabetes, memory-loss, osteoporosis, prostate health, modulation of stem cell activity and premature death. Testosterone replacement therapy (TRT) can influence these, so it is important to be able to recognise testosterone deficiency syndrome (TDS) which is defined as an absolute or relative deficiency of testosterone or its metabolites according to the needs of that individual at that time in his life. Reduced testosterone levels have somatic, psychological and sexual effects and their recognition is important in reaching a diagnosis.
- 1. The symptoms of TDS can be quickly assessed using ‘The Aging Male Symptoms (AMS) Scale’.
- A drug and alcohol history can reveal causes of low testosterone levels.
- A careful examination for the signs of TDS and associated conditions is needed.
- TT, SHBG, cFT, and gonadotrophins need measuring.
- Exercise stress testing, DEXA scanning, glucose tolerance testing, and body fat can reveal complications of TDS.
- Consider impaired androgen action and androgen resistance.
- TRT needs to be carefully chosen and monitored.
There is poor correlation between the symptoms of testosterone deficiency syndrome and blood androgen levels. It is important to fully assess each patient, document the diagnosis as fully as possible and actively look for aetiologies and complications of testosterone deficiency. Testosterone deficiency can be easily and safely treated and since treatment is often life-long, a careful structured approach to assessment is needed.
