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Expert panel will examine contrasting guidelines for testosterone deficiency
on: May 04, 2019
Expert panel will examine contrasting guidelines for testosterone deficiency
Abraham Morgentaler, MD
The use of hormone therapy to treat testosterone deficiency offers benefits to some men, but different treatment guidelines complicate matters for urologists. A multidisciplinary panel of experts will help AUA 2019 attendees sort through the current science during Sunday’s plenary presentation Complex Cases: Androgens: Charting the Course through the Sea of Guidelines, which will begin at 8:40 am in Room W375e at McCormick Place West.
“Testosterone therapy is a relatively recent topic that has become accepted by multiple professional organizations, many of which have developed treatment guidelines, including the AUA, which published its first guidelines regarding testosterone within the last year,” said Abraham Morgentaler, MD, who will moderate the session. Dr. Morgentaler is Director of Men’s Health Boston, associate clinical professor of Urology at Harvard Medical School and President of the Androgen Society.
“As with all guidelines, there remain areas of uncertainty, so the goal of this session is to look at the different guidelines and help clinicians try to figure out how to best treat their patients,” Dr. Morgentaler said. “The panel we’ve assembled includes both urologists and endocrinologists, who will be presented with several cases and asked how they would approach those patients.
“The foremost issue, and one where differences in guideline recommendations can cause some confusion, is determining which patients are appropriate candidates for testosterone therapy,” Dr. Morgentaler said.
“The diagnosis of testosterone deficiency in a patient requires two things: the presence of symptoms or signs that are characteristic of low levels of testosterone and confirmation with a blood test that shows low levels of testosterone,” Dr. Morgentaler said. “The challenge for clinicians is that nobody agrees on what that number should be for a testosterone concentration, and there’s even some debate about which is the right test.”
In the AUA guideline, low testosterone is defined as a serum total testosterone level of less than 300ng/dl. The European Association of Urology uses a higher value of approximately 348 ng/dl and the Endocrine Society advocates a much lower level of 264 ng/dl.
“You can have a patient who presents with characteristic symptoms of testosterone deficiency and, depending on which guideline you’re using, you may think that he is or is not a candidate for treatment,” Dr. Morgentaler said. “So that very same patient is likely to be treated differently depending on where he is being treated and who is treating him.”
Another area of controversy involves the question of whether total testosterone or free testosterone is the more important indicator of a man’s testosterone status.
“Relatively new data from the European Male Aging Study have shown that symptoms of testosterone deficiency correspond much more closely with free testosterone levels than total testosterone levels,” Dr. Morgentaler said.
One of the cases the panel will examine involves the use of testosterone in a man with a history of prostate cancer. “For decades it was universally believed that any history of prostate cancer was a contraindication to testosterone therapy because it could potentially cause the cancer to recur or to grow rapidly,” Dr. Morgentaler said. “However, we now have a very large population of men in the U.S. who have been diagnosed and treated for prostate cancer with excellent prognoses for the rest of their lives, and some of those men have testosterone deficiency.”
While data from randomized controlled trials are limited, Dr. Morgentaler said some observational data and case theories suggest that men who have been treated with testosterone despite a diagnosis of prostate cancer seem to do well.
“So we’re caught in a bit of a balancing act of trying to treat the symptoms of testosterone deficiency in these patients versus the theoretical risk that has been a concern for decades that there may be an increased risk of the cancer coming back,” he said. “It will be interesting to hear from the experts about how they weigh the different risks and benefits of treatment, and how they make a decision.”
on: May 04, 2019
Expert panel will examine contrasting guidelines for testosterone deficiency
Abraham Morgentaler, MD
The use of hormone therapy to treat testosterone deficiency offers benefits to some men, but different treatment guidelines complicate matters for urologists. A multidisciplinary panel of experts will help AUA 2019 attendees sort through the current science during Sunday’s plenary presentation Complex Cases: Androgens: Charting the Course through the Sea of Guidelines, which will begin at 8:40 am in Room W375e at McCormick Place West.
“Testosterone therapy is a relatively recent topic that has become accepted by multiple professional organizations, many of which have developed treatment guidelines, including the AUA, which published its first guidelines regarding testosterone within the last year,” said Abraham Morgentaler, MD, who will moderate the session. Dr. Morgentaler is Director of Men’s Health Boston, associate clinical professor of Urology at Harvard Medical School and President of the Androgen Society.
“As with all guidelines, there remain areas of uncertainty, so the goal of this session is to look at the different guidelines and help clinicians try to figure out how to best treat their patients,” Dr. Morgentaler said. “The panel we’ve assembled includes both urologists and endocrinologists, who will be presented with several cases and asked how they would approach those patients.
“The foremost issue, and one where differences in guideline recommendations can cause some confusion, is determining which patients are appropriate candidates for testosterone therapy,” Dr. Morgentaler said.
“The diagnosis of testosterone deficiency in a patient requires two things: the presence of symptoms or signs that are characteristic of low levels of testosterone and confirmation with a blood test that shows low levels of testosterone,” Dr. Morgentaler said. “The challenge for clinicians is that nobody agrees on what that number should be for a testosterone concentration, and there’s even some debate about which is the right test.”
In the AUA guideline, low testosterone is defined as a serum total testosterone level of less than 300ng/dl. The European Association of Urology uses a higher value of approximately 348 ng/dl and the Endocrine Society advocates a much lower level of 264 ng/dl.
“You can have a patient who presents with characteristic symptoms of testosterone deficiency and, depending on which guideline you’re using, you may think that he is or is not a candidate for treatment,” Dr. Morgentaler said. “So that very same patient is likely to be treated differently depending on where he is being treated and who is treating him.”
Another area of controversy involves the question of whether total testosterone or free testosterone is the more important indicator of a man’s testosterone status.
“Relatively new data from the European Male Aging Study have shown that symptoms of testosterone deficiency correspond much more closely with free testosterone levels than total testosterone levels,” Dr. Morgentaler said.
One of the cases the panel will examine involves the use of testosterone in a man with a history of prostate cancer. “For decades it was universally believed that any history of prostate cancer was a contraindication to testosterone therapy because it could potentially cause the cancer to recur or to grow rapidly,” Dr. Morgentaler said. “However, we now have a very large population of men in the U.S. who have been diagnosed and treated for prostate cancer with excellent prognoses for the rest of their lives, and some of those men have testosterone deficiency.”
While data from randomized controlled trials are limited, Dr. Morgentaler said some observational data and case theories suggest that men who have been treated with testosterone despite a diagnosis of prostate cancer seem to do well.
“So we’re caught in a bit of a balancing act of trying to treat the symptoms of testosterone deficiency in these patients versus the theoretical risk that has been a concern for decades that there may be an increased risk of the cancer coming back,” he said. “It will be interesting to hear from the experts about how they weigh the different risks and benefits of treatment, and how they make a decision.”
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