Abstract
Testosterone deficiency (TD) profoundly affects men’s quality of life. Men receiving testosterone therapy often experience resolution or improvement in their sexual symptoms and non-sexual health benefits. Although testosterone has been available since 1930s, the diagnosis and management of TD can be challenging and many controversies still exist. Clinical assessment based on symptoms and signs with a confirmatory testosterone level below normal range are required for diagnosis of TD. Screening for TD in the general population is not recommended. Screening for TD should be taken in men who report symptoms or signs associated with TD, particularly sexual dysfunctions as well as in men with obesity, type 2 diabetes, and metabolic syndrome. The International Society for Sexual Medicine recommended that symptomatic men with total T <350 ng/dL (12 nmol/L) should be treated with T therapy and a trial of T therapy in symptomatic men with total T levels >350 ng/dL can be considered based on clinical presentation. Patients who report no symptomatic improvement after at least 3 to 6 months of testosterone therapy despite adequate serum T levels should discontinue treatment.
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