madman
Super Moderator
Testosterone Therapy in Adult Males with Hypogonadism (2025)
Luca Boeri, Andrea Salonia, Thomas Masterson, John P. Mulhall, Leen Antonio, Giovanni Corona, Mohit Khera
Abstract
Background and objective
Testosterone deficiency (TD) is a common condition affecting patients’ health and quality of life. Clinical management has changed over the past decades, particularly regarding the indications and outcomes of testosterone therapy (TTh). Our aim was to provide an overview of the available evidence supporting the use of TTh in adult men with TD.
Methods
A nonsystematic literature review was conducted to identify relevant studies on the diagnosis and treatment of TD. The review encompassed lifestyle and pharmacological approaches, summarizing recent advances and highlighting persisting gaps in clinical practice.
Key findings and limitations
Testosterone deficiency in adult men typically presents with mild, nonspecific symptoms often related to aging, including sexual dysfunction, fatigue, mood changes, and reduced muscle and bone mass. Diagnosis requires a thorough clinical assessment and confirmation of low serum total testosterone. TTh is the standard treatment for symptomatic men with TD and low testosterone levels. Evidence indicates that TTh improves sexual function, body composition, metabolic profile, and bone mineral density without increasing the risk of major cardiovascular events or prostate cancer. Current guidelines recommend maintaining testosterone within the midnormal range (450–600 ng/dl) and monitoring hematocrit, prostate-specific antigen, and metabolic parameters. Follow-up should occur at 3 mo and every 6–12 mo thereafter, with individualized adjustments based on clinical response and safety.
Conclusions and clinical implications
TTh is a safe and effective treatment for TD. The selection of the most suitable product should consider patient needs and preferences, as well as the physician’s perspective.
3. Results
3.1 Definition
3.2 Prevalence
3.3 Classification
3.4 Potential consequences
3.5 Diagnosis
3.6 Contraindications
3.7 TTh outcomes
4. Discussion
4.1. Options for TD treatment
4.1.1. Lifestyle modification
4.1.2. GLP-1 analogs
4.1.3. Testosterone therapy
4.1.3.1. Oral testosterone
4.1.3.2. Transdermal testosterone
4.1.3.3. Transmucosal testosterone
4.1.3.4. Injectable testosterone
4.1.3.5. Implantable T pellets.
4.2 Modality selection
4.3 Monitoring
Conclusion
Symptomatic TD, as defined by both low serum T levels (<11 nmol/l) and sexual symptoms, is a condition affecting up to 2% of individuals in the general population, but prevalence rates are higher if biochemical thresholds alone are considered. The correct diagnosis should be based on a combination of a thorough andrological and general physical examination, and specific blood tests. Several T preparations are available. The selection of the most suitable product should take into account patient needs and preferences, as well as physician’s perspective. When TD is diagnosed appropriately and TTh is prescribed and monitored according to the available recommendations, the risks are limited. In particular, no increased risk of major CV or prostate-related events has been reported.
