title: The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men.
abstract: BACKGROUND
  In 2014, the International Society for Sexual Medicine (ISSM) convened a panel of experts to develop an evidence-based process of care for the diagnosis and management of testosterone deficiency (TD) in adult men. The panel considered the definition, epidemiology, etiology, physiologic effects, diagnosis, assessment and treatment of TD. It also considered the treatment of TD in special populations and commented on contemporary controversies about testosterone replacement therapy, cardiovascular risk and prostate cancer.
  
  
  OBJECTIVE
  The aim was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of diagnosis and management of TD for clinicians without expertise in endocrinology, such as physicians in family medicine and general urology practice.
  
  
  METHODS
  A comprehensive literature review was performed, followed by a structured, 3-day panel meeting and 6-month panel consultation process using electronic communication. The final guideline was compiled from reports by individual panel members on areas reflecting their special expertise, and then agreed by all through an iterative process.
  
  
  RESULTS
  This article contains the report of the ISSM TD Process of Care Committee. It offers a definition of TD and recommendations for assessment and treatment in different populations. Finally, best practice treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with TD.
  
  
  CONCLUSIONS
  Development of a process of care is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to new insights into the pathophysiology of TD, as well as new, efficacious and safe treatments. We recommend that this process of care be reevaluated and updated by the ISSM in 4 years.
authors.affiliation: Gender and Sexual Medicine, Devon Partnership NHS Trust, Exeter, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Dean
authors.affiliation: Australian Center for Sexual Health, Sydney, NSW, Australia.
authors.forename: Chris G
authors.initials: CG
authors.lastname: McMahon
authors.affiliation: Center for Sexual Function, Lahey Clinic Northshore, Peabody, MA, USA.|Endocrinology, Harvard Medical School, Boston, MA, USA.
authors.forename: Andre T
authors.initials: AT
authors.lastname: Guay
authors.affiliation: Department of Urology, Harvard Medical School, Boston, MA, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Morgentaler
authors.affiliation: Urology, Case Western Reserve, University School of Medicine, West Palm Beach, FL, USA.
authors.forename: Stanley E
authors.initials: SE
authors.lastname: Althof
authors.affiliation: Division of Urology, Hospital de Clinicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
authors.forename: Edgardo F
authors.initials: EF
authors.lastname: Becher
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.affiliation: Centre d'Etudes et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Buvat
authors.affiliation: Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: El Meliegy
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Wayne J G
authors.initials: WJ
authors.lastname: Hellstrom
authors.affiliation: Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Emmanuele A
authors.identifier: http://orcid.org/0000-0002-5874-039X
authors.initials: EA
authors.lastname: Jannini
authors.affiliation: Department Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
authors.affiliation: Division of Urology, Albany Medical College, Albany, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: McCullough
authors.affiliation: Clinica de Urologia e Andrologia, Belo Horizonte, Brazil.
authors.forename: Luiz Otavio
authors.initials: LO
authors.lastname: Torres
authors.affiliation: Centre for Reproductive Medicine and Andrology/Clinical Andrology, University Clinics Müenster, Münster, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zitzmann
mesh_terms: D000328:Adult; D017668:Age of Onset; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D020249:Hormone Replacement Therapy; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D008297:Male; D008991:Monitoring, Physiologic; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000517:prevention & control*; D012307:Risk Factors; D012955:Societies, Medical; D013739:Testosterone / Q000172:deficiency / Q000627:therapeutic use*
chemical_list: D013739:Testosterone
keywords: Assessment of Hypogonadism; Etiology of Hypogonadism; Hypogonadism; Testosterone Deficiency; Treatment of Hypogonadism