Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and ASA Recommendations
Article first published online: 2 JAN 2013
2009 American Society of Andrology
Journal of Andrology
Volume 30, Issue 1, pages 1–9, January-February 2009
How to Cite
Wang, C., Nieschlag, E., Swerdloff, R., Behre, H. M., Hellstrom, W. J., Gooren, L. J., Kaufman, J. M., Legros, J.-J., Lunenfeld, B., Morales, A., Morley, J. E., Schulman, C., Thompson, I. M., Weidner, W. and Wu, F. C. W. (2009), Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and ASA Recommendations. Journal of Andrology, 30: 1–9. doi: 10.2164/jandrol.108.006486
- Issue published online: 2 JAN 2013
- Article first published online: 2 JAN 2013
- Received for publication August 7, 2008; accepted for publication August 20, 2008
- AACE Hypogonadism Task Force. American Association of Clinical Endocrinologist Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hypogonadism in Adult Male Patients-Update 2002. http:wwwaacecompubpdfguidelineshypogonadismpdf [serial online]. Accessed May 18, 2008.
- Testosterone replacement therapy after primary treatment for prostate cancer. J Urol. 2005;173: 533–536. , .
- Testosterone therapy prevents gain in visceral adipose tissue and loss of skeletal muscle in nonobese aging men. J Clin Endocrinol Metab. 2008;93: 139–146. , , , , .
- Lifestyle and nutritional determinants of bioavailable androgens and related hormones in British men. Cancer Causes Control. 2002;13: 353–363. , , , .
- Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone. J Clin Endocrinol Metab. 2004;89: 503–510. , , , , , , , .
- Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92: 4241–4247. , , , , , , , .
- Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the massachusetts male aging study. J Clin Endocrinol Metab. 2004;89: 5920–5926. , , , , , , .
- Effect of 2 years of testosterone replacement on insulin secretion, insulin action, glucose effectiveness, hepatic insulin clearance, and postprandial glucose turnover in elderly men. Diabetes Care. 2007;30: 1972–1978. , , , , , , , , , , .
- Correlations between hormones, physical, and affective parameters in aging urologic outpatients. Eur Urol. 2005;47: 749–755. , , , , , , .
- Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91: 1995–2010. , , , , , , .
- Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl. 2003;24: 299–311. , , , , , .
- The reliability of clinical and biochemical assessment in symptomatic late-onset hypogonadism: can a case be made for a 3-month therapeutic trial? BJU Int. 2004;94: 1066–1070. , , .
- Pituitary radiographic abnormalities and clinical correlates of hypogonadism in elderly males presenting with erectile dysfunction. Aging Male. 2002;5: 38–46. , , , .
- Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy. J Urol. 1997;158: 1764–1767. , .
- Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60: 1451–1457. , , , , , , .
- Getting over testosterone: postulating a fresh start for etiologic studies of prostate cancer. J Natl Cancer Inst. 2008;100: 158–159. , , .
- Prevalence of hypothalamic-pituitary imaging abnormalities in impotent men with secondary hypogonadism. J Urol. 1996;155: 529–533. , , , , , , , .
- Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control. Metabolism. 2004;53: 666–672. , , , , , , , .
- Body mass index, waist circumference and waist to hip ratio and change in sex steroid hormones: the Massachusetts Male Ageing Study. Clin Endocrinol (Oxf). 2006;65: 125–131. , , , , .
- Diurnal rhythms of serum total, free and bioavailable testosterone and of SHBG in middle-aged men compared with those in young men. Clin Endocrinol (Oxf). 2003;58: 710–717. , , , , .
- Polycythemia as a complication of testosterone replacement therapy in nursing home men with low testosterone levels. J Am Geriatr Soc. 1995;43: 899–901. , , , , , .
- Considerations for the use of testosterone with systemic chemotherapy in prostatic cancer. Cancer. 1982;49: 1373–1377. , .
- Rate and circumstances of clinical vertebral fractures in older men. Osteoporos Int. 2008;19: 615–623. , , , , , , , .
- Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 1991;73: 1016–1025. , , , .
- Does sildenafil combined with testosterone gel improve erectile dysfunction in hypogonadal men in whom testosterone supplement therapy alone failed? J Urol. 2005;173: 530–532. , , , , , .
- Testosterone therapy and obstructive sleep apnea: is there a real connection? J Sex Med. 2007;4: 1241–1246. .
- Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86: 724–731. , , , , .
- Can results of the Aging Males' Symptoms (AMS) scale predict those of screening scales for androgen deficiency? Aging Male. 2004;7: 211–218. , , , .
- Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf). 2005a;63: 381–394. , , , , , , , , .
- Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf). 2005b;63: 280–293. , , , , , , , .
- Androgen deficiency, diabetes, and the metabolic syndrome in men. Curr Opin Endocrinol Diabetes Obes. 2007;14: 226–234. , .
- Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care. 2007;30: 911–917. , , , , .
- Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol. 2006;154: 899–906. , , , .
- Androgen replacement after curative radical prostatectomy for prostate cancer in hypogonadal men. J Urol. 2004;172: 920–922. , .
- Blood testosterone threshold for androgen deficiency symptoms. J Clin Endocrinol Metab. 2004;89: 3813–3817. , , .
- Short-term effects of intramuscular and transdermal testosterone on bone turnover, prostate symptoms, cholesterol, and hematocrit in men over age 70 with low testosterone levels. Endocr Res. 2000;26: 153–168. , , .
- The role of testosterone replacement therapy following radical prostatectomy. Urol Clin North Am. 2007;34: 549–53, vi. , .
- Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab. 2006;91: 843–850. , , , , , .
- Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004;27: 1036–1041. , , , , , , , .
- Testosterone and Aging: Clinical Research Directions. Washington, DC: National Academies Press; 2004. , .
- Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. Eur Heart J. 2006;27: 57–64. , , , , , .
- Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006;296: 2351–2361. , , , , , , , , , , , .
- Prostatic growth: new insights into hormonal regulation. Br J Urol. 1995;76(suppl 1): 5–10. .
- Endogenous sex hormones and incident fracture risk in older men: the Dubbo Osteoporosis Epidemiology Study. Arch Intern Med. 2008;168: 47–54. , , , , , , , , , .
- Prostate size in hypogonadal men treated with a nonscrotal permeation-enhanced testosterone transdermal system. Urology. 1997;49: 191–196. , , , , , , , , , .
- The Aging Males' Symptoms scale (AMS) as outcome measure for treatment of androgen deficiency. Eur Urol. 2004;46: 80–87. , , , , , .
- Endocrine aspects of sexual dysfunction in men. J Sex Med. 2004;1: 69–81. , , , , , , .
- Investigation, treatment and monitoring of late-onset hypogonadism in males. Official recommendations of ISSAM. International Society for the Study of the Aging Male. Aging Male. 2002;5: 74–86. , .
- Testosterone Deficiency Syndrome (TDS) needs to be named appropriately—the importance of accurate terminology. Eur Urol. 2006;50: 407–409. , , , .
- Adding to the controversy: pitfalls in the diagnosis of testosterone deficiency syndromes with questionnaires and biochemistry. Aging Male. 2007;10: 57–65. , , , , , , .
- Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000;49: 1239–1242. , , , , , , .
- Testosterone treatment comes of age: new options for hypogonadal men. Clin Endocrinol (Oxf). 2006;65: 275–281. .
- Testosterone: Action, Deficiency, Substitution. 3rd ed. Cambridge, United Kingdom: Cambridge University Press; 2004. , .
- Investigation, treatment and monitoring of late-onset hypogonadism in males. Aging Male. 2005a;8: 56–58. , , , , , , , , , , , .
- Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU recommendations. Int J Androl. 2005b;28: 125–127. , , , , , , , , , , , .
- Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU recommendations. Eur Urol. 2005c;48: 1–4. , , , , , , , , , , , .
- Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU recommendations. J Androl. 2006;27: 135–137. , , , , , , , , , , , .
- Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab. 2005;90: 1502–1510. , , , , , , .
- External validation of the Prostate Cancer Prevention Trial risk calculator in a screened population. Urology. 2006;68: 1152–1155. , , , , , , , , .
- Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy. Cancer Epidemiol Biomarkers Prev. 2005;14: 2257–2260. , , , , , .
- The value of pituitary magnetic resonance imaging in men with hypogonadism. J Urol. 2003;170: 795–798. , , , .
- Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004;350: 482–492. , .
- Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008;100: 170–183. , , , .
- Aging, androgens, and the metabolic syndrome in a longitudinal study of aging. J Clin Endocrinol Metab. 2007;92: 3568–3572. , , , , , , .
- Errors in the measurement of plasma free testosterone. J Clin Endocrinol Metab. 1997;82: 2014–2015. .
- Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab. 2007;92: 405–413. , , , , .
- Testosterone replacement for hypogonadism after treatment of early prostate cancer with brachytherapy. Cancer. 2007;109: 536–541. .
- The relationship between pituitary-gonadal function and sexual behavior in healthy aging men. Psychosom Med. 1991;53: 363–374. , , , .
- Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA. 2007;298: 629–637. , , , , , , , , .
- Androgens and diabetes in men: results from the Third National Health and Nutrition Examination Survey (NHANES III). Diabetes Care. 2007;30: 234–238. , , , , , , , , , .
- Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol. 2004;172: 658–663. , , , .
- Reproductive hormone reference intervals for healthy fertile young men: evaluation of automated platform assays. J Clin Endocrinol Metab. 2005;90: 5928–5936. , , , , , .
- Effect of testosterone treatment on bone mineral density in men over 65 years of age. J Clin Endocrinol Metab. 1999a;84: 1966–1972. , , , , , , , , , , , , .
- Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab. 1999b;84: 2647–2653. , , , , , , , , , , .
- Free testosterone measurement by the analog displacement direct assay: old concerns and new evidence. Clin Chem. 2008;54: 458–460. , .
- Testosterone measured by 10 immunoassays and by isotope-dilution gas chromatography-mass spectrometry in sera from 116men, women, and children. Clin Chem. 2003;49: 1381–1395. , , , , , , , , .
- Interest of the androgen deficiency in aging males (ADAM) questionnaire for the identification of hypogonadism in elderly community-dwelling male volunteers. Eur J Endocrinol. 2004;151: 355–360. , , , , , , .
- Practice Committee of the American Society for Reproductive Medicine. Treatment of androgen deficiency in the aging male. Fertil Steril. 2004;81: 1437–1440.
- Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2006a;98: 529–534. , , , , , , , , .
- Recommendations for defining and treating high risk localized prostate cancer. J Urol. 2006b;176: S6–S10. , , .
- The relationship between libido and testosterone levels in aging men. J Clin Endocrinol Metab. 2006;91: 2509–2513. , , , , .
- Hormonal cut-offs of partial androgen deficiency: a survey of androgen assays. J Endocrinol Invest. 2005;28: 28–31. .
- A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84: 3666–3672. , , .
- Measurement of total serum testosterone in adult men: comparison of current laboratory methods versus liquid chromatography-tandem mass spectrometry. J Clin Endocrinol Metab. 2004;89: 534–543. , , , , .
- Salivary testosterone in men: further evidence of a direct correlation with free serum testosterone. J Clin Endocrinol Metab. 1981;53: 1021–1024. , , , .
- Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab. 2008;93: 2737–2745. , , , , , , , , , , , , , , .
- Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab. 2006;91: 4335–4343. , , .
- Androgen receptor gene CAG repeat length and body mass index modulate the safety of long-term intramuscular testosterone undecanoate therapy in hypogonadal men. J Clin Endocrinol Metab. 2007;92: 3844–3853. , .