title: EMAS position statement: Testosterone replacement therapy in the aging male‏.
abstract: BACKGROUND
  Late-onset hypogonadism (LOH) represents a common clinical entity in aging males, characterized by the presence of symptoms (most usually of a sexual nature, such as decreased libido, decreased spontaneous erections and erectile dysfunction) and signs, in combination with low serum testosterone concentrations. Whether testosterone replacement therapy (TRT) should be offered to those individuals is still under extensive debate.
  
  
  OBJECTIVE
  The aim of this position statement is to provide and critically appraise evidence on TRT in the aging male, focusing on pathophysiology and characteristics of LOH, indications for TRT, available therapeutic agents, monitoring and treatment-associated risks.
  
  
  METHODS
  Literature review and consensus of expert opinion.
  
  
  CONCLUSIONS
  Diagnosis and treatment of LOH is justified, if a combination of symptoms of testosterone deficiency and low testosterone is present. Patients receiving TRT could profit with regard to obesity, metabolic syndrome, type 2 diabetes mellitus, sexual function and osteoporosis and should undergo scheduled testing for adverse events regularly. Potential adverse effects of TRT on cardiovascular disease, prostate cancer and sleep apnea are as yet unclear and remain to be investigated in large-scale prospective studies. Management of aging men with LOH should include individual evaluation of co-morbidities and careful risk versus benefit assessment.
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ring Road -Nea Efkarpia, 564 29 Thessaloniki, Greece. Electronic address: chdimo@hotmail.com.
authors.forename: Christina
authors.initials: C
authors.lastname: Dimopoulou
authors.affiliation: Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, and Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania.
authors.forename: Iuliana
authors.initials: I
authors.lastname: Ceausu
authors.affiliation: Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Herman
authors.initials: H
authors.lastname: Depypere
authors.affiliation: Second Department of Obstetrics and Gynecology, National and Capodestrian University of Athens, Greece.
authors.forename: Irene
authors.initials: I
authors.lastname: Lambrinoudaki
authors.affiliation: University Women's Hospital of Tuebingen, Calwer Street 7, 72076 Tuebingen, Germany.
authors.forename: Alfred
authors.initials: A
authors.lastname: Mueck
authors.affiliation: Department of Obstetrics and Gynecology, Zaragoza University Facultad de Medicina, Hospital Clínico, Zaragoza 50009, Spain.
authors.forename: Faustino R
authors.initials: FR
authors.lastname: Pérez-López
authors.affiliation: Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Rees
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Istanbul University Cerrahpasa School of Medicine Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Turkey.
authors.forename: Levent M
authors.initials: LM
authors.lastname: Senturk
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Simonsini
authors.affiliation: National Heart and Lung Institute, Imperial College London, Royal Brompton Campus Hospital, London SW3 6NP, UK.
authors.forename: John C
authors.initials: JC
authors.lastname: Stevenson
authors.affiliation: Department of Obstetrics and Gynecology, University of Bern, Switzerland.
authors.forename: Petra
authors.initials: P
authors.lastname: Stute
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Goulis
mesh_terms: D000375:Aging / Q000502:physiology*; D032921:Consensus; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D007172:Erectile Dysfunction / Q000209:etiology; D019317:Evidence-Based Medicine; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D009765:Obesity / Q000150:complications; D010024:Osteoporosis / Q000150:complications; D013739:Testosterone / Q000097:blood / Q000627:therapeutic use*
chemical_list: D013739:Testosterone
keywords: Aging male; Late-onset hypogonadism; Testosterone replacement