title: Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations.
abstract: BACKGROUND
  Part 1 of this position statement dealt with the assessment of male hypogonadism, including the indications for testosterone therapy. This article, Part 2, focuses on treatment and therapeutic considerations for male hypogonadism and identifies key questions for future research.
  
  
  CONCLUSIONS
  Key points and recommendations are:Excess cardiovascular events have been reported in some but not all studies of older men without pathological hypogonadism who were given testosterone treatment. Additional studies are needed to clarify whether testosterone therapy influences cardiovascular risk.Testosterone is the native hormone that should be replaced in men being treated for pathological hypogonadism. Convenient and cost-effective treatment modalities include depot intramuscular injection and transdermal administration (gel, cream or liquid formulations).Monitoring of testosterone therapy is recommended for efficacy and safety, focusing on ameliorating symptoms, restoring virilisation, avoiding polycythaemia and maintaining or improving bone mineral density.Treatment aims to relieve an individual's symptoms and signs of androgen deficiency by administering standard doses and maintaining circulating testosterone levels within the reference interval for eugonadal men.Evaluation for cardiovascular disease and prostate cancer risks should be undertaken as appropriate for eugonadal men of similar age. Nevertheless, when there is a reasonable possibility of substantive pre-existing prostate disease, digital rectal examination and prostate-specific antigen testing should be performed before commencing testosterone treatment.Changes in management as result of the position statement: Treatment aims to relieve symptoms and signs of androgen deficiency, using convenient and effective formulations of testosterone. Therapy should be monitored for efficacy and safety.
authors: School of Medicine and Pharmacology, University of Western Australia, Perth, WA bu.yeap@uwa.edu.au.
authors: Bu B
authors: BB
authors: Yeap
authors: Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC.
authors: Mathis
authors: M
authors: Grossmann
authors: Hudson Institute of Medical Research, Melbourne, VIC.
authors: Robert I
authors: RI
authors: McLachlan
authors: ANZAC Research Institute, University of Sydney, Sydney, NSW.
authors: David J
authors: DJ
authors: Handelsman
authors: Discipline of Medicine, University of Adelaide, Adelaide, SA.
authors: Gary A
authors: GA
authors: Wittert
authors: ANZAC Research Institute, University of Sydney, Sydney, NSW.
authors: Ann J
authors: AJ
authors: Conway
authors: School of Medicine and Pharmacology, University of Western Australia, Perth, WA.
authors: Bronwyn Ga
authors: BG
authors: Stuckey
authors: Endocrinology, Cabrini Hospital, Melbourne, VIC.
authors: Douglas W
authors: DW
authors: Lording
authors: Hudson Institute of Medical Research, Melbourne, VIC.
authors: Carolyn A
authors: CA
authors: Allan
authors: Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC.
authors: Jeffrey D
authors: JD
authors: Zajac
authors: Hudson Institute of Medical Research, Melbourne, VIC.
authors: Henry G
authors: HG
authors: Burger
mesh_terms: D000279:Administration, Cutaneous; D001315:Australia; D002318:Cardiovascular Diseases / Q000150:complications*; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D012016:Reference Values; D012307:Risk Factors; D012955:Societies, Medical; D013739:Testosterone / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D013739:Testosterone; D017430:Prostate-Specific Antigen