In April 2018, the American Urological Association (AUA) released the first-ever clinical guideline on the diagnosis and management of testosterone deficiency.
Earlier this week, the Urology Care Podcast traveled to New York City to interview Dr. John Mulhall, Director of Male Sexual and Reproductive Medicine at Memorial Sloan Kettering Cancer Center and chair of the panel that developed this guideline. Dr. Mulhall outlined what patients should know and how the guideline may impact them.
Listen to the entire podcast with Dr. Mulhall.
Dr. Mulhall opened up the interview by describing a clinical guideline as a document developed by a panel of experts who review all available information to come with up recommendations. These recommendations help guide health care providers in optimizing the care of patients. Dr. Mulhall added that a guideline is not an absolute or inflexible way to care for a patient. This is because there are exceptions and special cases in regards to what is best for the individual patient.
Testosterone is a vital hormone produced by the testicles and can be measured using a blood test. As men age, their natural ability to produce testosterone becomes less effective and testosterone levels begin to decline about 1-3 percent a year starting after the age of 40. This natural decline, however, does not imply a man is testosterone deficient or a candidate for testosterone therapy.
Testosterone deficiency is not simply defined as a state of low testosterone production, but rather a state of low testosterone production combined with low testosterone symptoms such as a lower sex drive, erectile dysfunction, loss of energy, reduced muscle mass or bone density and fatigue. Therefore, a man is considered testosterone deficient and a candidate for testosterone therapy only when he meets both criteria.
As part of this new guideline, clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone which Dr. Mulhall further explained during the podcast.
Dr. Mulhall also mentioned the diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion.
In addition, Dr. Mulhall noted that the guideline advises clinicians to consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even without symptoms or signs associated with testosterone deficiency.
Cardiovascular Safety, Infertility and Prostate Cancer
During the podcast, Dr. Mulhall also touched on what testosterone deficient patients with concerns of cardiovascular safety should know about the new guideline. This includes patients that have recently had a heart attack or stroke.
The new guideline addresses patients who may have testosterone deficiency and fertility concerns which Dr. Mulhall also spoke about. Prostate cancer patients and those who may be at a higher risk for prostate cancer were also addressed during this podcast interview. This is because the new guideline may impact those patients.
The new guideline recommends men should be measured every 6-12 months while on testosterone therapy. Given the large scope of what this guideline covers, Dr. Mulhall ended the interview with facts on what patients should know about follow-up care.
Other patient education resources on testosterone deficiency include: