Conversely, a recent study exposing patient testes to radiation (3 patients 17Gy and 4 patients 24Gy) demonstrated normal testosterone levels up to 3 years after radiation exposure.147 A retrospective review of 399 men (mean age 37 years) with a mean total testosterone of 308 ng/dL found that 35% of patients had BMD at osteopenic levels and 3% had osteoporosis. Specifically, the odds ratio for developing ED in men with total testosterone 6 used a single question to define ED and also showed an increase in ED risk as total testosterone levels decreased. Furthermore, additional testing, such as parathyroid hormone, calcium, and vitamin D levels, may be required. Given the link between LTBF and morbidity and mortality in older men, evaluating bone density is an important step in the assessment of patients with testosterone deficiency. Study duration was also short, with only one study performed for 52 weeks.229 This may underestimate the true benefits of therapy as long-term prospective data suggest ongoing and slowly progressive improvements in erectile function occurring up to three years after treatment initiation.297 Be sure to speak with your doctor or clinician on which method is best for you and your health needs. Research has shown this method of TRT is not just effective, but also ensures you administer the same dose every single time (3). However, when you’re undergoing TRT, some people test to determine the peak amount of testosterone, and some people try to grab the trough, says McDevitt. The Panel recommends that clinicians use the same laboratory with the same method/instrumentation for serial total testosterone measurement. Other population-based studies have attempted to measure prevalence, but have not used standard methodology, which makes arriving at a definitive number of testosterone deficiency difficult. Considering the inherent confusion surrounding testosterone therapy in the current prescribing landscape, the AUA believes it is imperative to be as explicit as possible and present the reader the most complete information, which will optimize the efficacy and safety of testosterone therapy. When body of evidence strength Grade C is used, there is uncertainty regarding the balance between benefits and risks/burdens, alternative strategies may be equally reasonable, and better evidence is likely to change confidence. Two RCTs compared treatment of testosterone deficient males with SERMs versus testosterone versus placebo and found that sperm concentration was maintained (comparable to placebo) for males treated with the SERMs, but was significantly decreased for males on exogenous testosterone.401, 402 Finally, Helo et al. conducted a prospective, double-blind, RCT comparing the SERM clomiphene citrate versus the AI anastrozole in infertile males with testosterone deficiency. It is rapidly metabolized in the liver; therefore, achieving consistently therapeutic testosterone levels is a challenge. In the absence of long-term RCTs evaluating whether testosterone therapy results in cardiovascular benefit or harm, the decision to use testosterone therapy in such patients should be based on a shared decision-making approach between clinicians and patients.
