American Urological Association Guidelines

Jinzang · Apr 11, 2018

The American Urological Association has published new guidelines on the evaluation and management of testosterone deficiency. Here are some guidelines I found interesting.

1. Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone.
2. The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion.
3. The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs.
14. Patients should be informed that testosterone therapy may result in improvements in erectile function, low sex drive, anemia, bone mineral density, lean body mass, and/or depressive symptoms.
22. Clinicians should adjust testosterone therapy dosing to achieve a total testosterone level in the middle tertile of the normal reference range.
28. Commercially manufactured testosterone products should be prescribed rather than compounded testosterone, when possible.
31. Clinicians should discuss the cessation of testosterone therapy three to six months after commencement of treatment in patients who experience normalization of total testosterone levels but fail to achieve symptom or sign improvement.

DragonBits · Apr 11, 2018

Lee Panelas said:
22. Clinicians should adjust testosterone therapy dosing to achieve a total testosterone level in the middle tertile of the normal reference range.

That begs the question, is that trough, or what?

My doctor doesn't measure trough. He measures 4 days after injection to get an "average" of between peak and trough. I wish they would be more specific in these so called guidelines as everyone has a differing opinion it seems.

Good point.

So the recommendation is to shoot for a level (if my math it right) of TT of 588 ng/dl. The middle tertile being 481-698 ng/dl. Or between 481-696 ng/dl TT, so somewhere in that range.

That in itself is lower than most men would like.

Blackhawk · Apr 11, 2018

Egads, and that comment on #22 taken in conjunction with #31... if the middle tertile doesn't do, deprive patient of treatment rather than try increased dosage/levels.

Saul · Apr 11, 2018

Similar to what my insurance company required for coverage - several tests below 300. They just don't want to pay, even though it is GP doctor recommened, I feel better, and all my other stats are better. But, Dr. go buy this stuff so they are following their rules and I would liability avoidance also plays into it. It is not as if urologists are short on work.

DragonBits · Apr 11, 2018

Saul said:
Similar to what my insurance company required for coverage - several tests below 300. They just don't want to pay, even though it is GP doctor recommened, I feel better, and all my other stats are better. But, Dr. go buy this stuff so they are following their rules and I would liability avoidance also plays into it. It is not as if urologists are short on work.

I have medicare.

While Medicare would likely not approve me for TRT, prescription drugs come under a different plan. My plan would honor a script for testosterone cypionate if my doctor ordered it. I would pay less than $2 for testosterone under my current plan.

HCG is NOT covered by my drug plan at all. Arimidex is on the plan.

How this would all play out, would my PCP doctor order any of these drugs, I don't know.

I

Jinzang · Apr 11, 2018

It's interesting what's not in the guidelines: recommendations on dosing and frequency of dose. I think doctors could use better guidance on these two points.

American Urological Association Guidelines

Jinzang

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DragonBits

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Blackhawk

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Saul

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Jinzang

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