Recommendations on the diagnosis, treatment and monitoring of testosterone deficiency in men

Figures & data

Table 1. Disorders and conditions most frequently associated with TD.

Sexual disorders: Low libido^a Poor morning erections^a Erectile dysfunction^a Difficulty in achieving orgasm or reduced intensity of orgasm	Somatic disorders and conditions: Insulin resistance Obesity, abdominal obesity^a Anemia Metabolic syndrome^a Arterial hypertension Dislipidemia Diabetes mellitus type 2^a Sarcopenia (decreased muscle mass and strength)^a Decreased bone mineral density and osteoporosis Chronic pain [43,44,45] Sleep apnoe
Psychological disorders Depressed mood Fatigue^a Decreased vitality^a Cognitive impairment

^aMost frequently associated with TD.

Table 2. Medications that may be the reason for low testosterone level/decreased testosterone bioactivity.

Glucocorticoids	Opioids
Antipsychotics	Statins
Alkylating agents	Methotrexate
Testosterone synthesis inhibitors	Ketoconazole
Aminogutethimide	Mitotane
Metyrapon	GnRH agonist or antagonist
Oestrogens	Progestogens (including cyproterone acetate)
Prolactin increasing agents	Drug-induced aromatase activity blockade Letrozole Anastrazole Exemestane
Drug-induced AR blockage Steroidal antiandrogen Cyproterone acetate Spironolactone Non-steroidal antiandrogen Flutamide Bicalutamide Nilutamide	Drug-induced 5α reductase activity blockade Finasteride Dutasteride Drug-induced ER blockade Clomiphene Tamoxifen Raloxifene

Figure 1. Threshold continuum to hypogonadism.

Figure 2. Saturation curve, demonstrating the relationship between testosterone and prostate cancer.

Figure 3. Time-dependent onset of effects of testosterone substitution therapy.

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