Testosterone deficiency (TD), often referred to as hypogonadism, is
associated with aging and affects approximately 30 percent of men ages
40-79. To highlight some of the challenges and controversies
encountered in diagnosis and treatment of men with TD, the authors of a
review article in the American Journal of Medicine introduced a
clinical vignette to illustrate the implication of TD on men's overall
health and analyzed a number of studies in men receiving Testosterone
Replacement Therapy (TRT) to treat TD. The article also provided an
algorithm for diagnosis and treatment and addressed the areas of concern
and uncertainty involving testosterone replacement therapy (TRT).
The clinical vignette depicted a 52 year old man of Caucasian
descent who presented with erectile dysfunction, diminished libido and
fatigue. He was 5 feet, 7 inches tall, weighed 217 pounds and had normal
blood and laboratory values, except that his blood pressure was high
and his serum total testosterone was low and his fasting serum glucose
and lipid profiles were high –indicating the presence of metabolic
syndrome.
In conclusion, the authors recommend that the man be treated for
2-3 months using TRT, with a follow up to determine the efficacy of the
TRT in increasing his testosterone levels to normal levels. Their
recommendations are in agreement with many published guidelines and show
that the TRT treatment, in conjunction with diet and exercise, will
help improve the man's sexual and physical health.
"This clinical vignette offers important information for general
practitioners and provides practical recommendations for diagnosing TD
and the novel treatment approaches that could positively impact the
overall health of middle-aged men," said Traish.
By introducing the clinical vignette as a teaching case study the
authors re-focused the attention on utilizing not only blood (serum)
test for testosterone, but also taking into account the sexual and
non-sexual physical symptoms into considerations. The authors also
indicated that current data failed to show a significant association
between TRT and prostate cancer. TRT has been shown to improve sexual
function in men with TD. According to a recent review article in the American Journal of Medicine, TRT might also improve the overall health of men.
