The benefits and risks of testosterone replacement therapy: a review

Figures & data

Figure 1 Approach to the diagnosis and treatment of late onset hypogonadism (ADAM = St. Louis University Androgen Deficiency in Aging Males Questionnaire).

Table 1 Androgen Deficiency In Ageing Male (ADAM) questionnaire

Do you have a decrease in libido or sex drive? Do you have a lack of energy? Do you have a decrease in strength and/or endurance? Have you lost weight? Have you noticed a decreased “enjoyment of life”? Are you sad and/or grumpy? Are your erections less strong? Have you noticed a recent deterioration in your ability to play sports? Are you falling asleep after dinner? Has there been a recent deterioration in your work performance?

A positive ADAM questionnaire was defined as “yes” for question 1 and 7, and 2–4 for all other items.

Table 2 Potential benefits of testosterone replacement therapy

Improve sexual desire and function

Increase bone mineral density

Improve mood, energy and quality of life

Change body composition and improve muscle mass and strength

Improve cognitive function

Table 3 Potential risks for testosterone replacement therapy

Stimulate growth of prostate cancer and breast cancer

Worsen symptoms of benign prostatic hypertrophy

Cause liver toxicity and liver tumor

Cause gynecomastia

Cause erythrocytosis

Cause testicular atrophy and infertility

Cause skin diseases

Cause or exacerbate sleep apnea

Table 4 When a urological consultation is needed

Verified serum PSA concentration more than 4.0 ng/mL An increase in serum PSA concentration more than 1.4 ng/mL within any 12-month period of testosterone treatment A PSA velocity of more than 0.4 ng/mL/year using the PSA level after 6 months of testosterone administration as the reference (only applicable if PSA data available >2 years) Detection of a prostatic abnormality on digital rectal examination An American Urological Association (AUA) or International Prostate Symptom Score (IPSS) prostate symptom score of more than 19

Abbreviation: PSA, prostate specific antigen.

Table 5 Contraindications to testosterone replacement therapy

Very high risk of serious adverse outcomes

Prostatic carcinoma

Breast cancer

Prostate nodules or indurations

Unexplained prostate-specific antigen (PSA) elevation

Erythrocytosis (hematocrit > 50%)

Severe lower urinary tract symptoms with benign prostatic hyperplasia with an International Prostate Symptom Score (IPSS) >19

Unstable congestive heart failure (class III or IV)

Severe untreated sleep apnea