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Clinical Intelligence

How to manage low testosterone level in men: a guide for primary care

Ahmed Al-Sharefi, Scott Wilkes, Channa N Jayasena and Richard Quinton
British Journal of General Practice 2020; 70 (696): 364-365. DOI: https://doi.org/10.3399/bjgp20X710729
Ahmed Al-Sharefi
Section of Investigative Medicine, Hammersmith Hospital, Imperial College London, London.
Roles: Specialty registrar in diabetes & endocrinology
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Scott Wilkes
University of Sunderland, Sunderland.
Roles: Professor of general practice & primary care and head of School of Medicine
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Channa N Jayasena
Section of Investigative Medicine, Hammersmith Hospital, Imperial College London, London.
Roles: Clinical senior lecturer and consultant in reproductive endocrinology & andrology
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Richard Quinton
Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne.
Roles: Senior Lecturer & Consultant in Endocrinology
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INTRODUCTION

Male hypogonadism is a clinical syndrome characterised by testosterone deficiency and impaired spermatogenesis; due either to diseases of the hypothalamus or pituitary gland, or of the testes themselves.1 The diagnosis requires the presence of clinical features consistent with lack of testosterone plus the finding of persistent and unequivocally low serum testosterone levels. Failure to recognise and treat men with hypogonadism may predispose them to long-term health problems, such as anaemia, osteoporosis, depression, or sexual dysfunction.

Over recent years, there has been a surge in testosterone prescriptions for men with sexual dysfunction or putative age-related decline in testosterone,2 possibly reflecting pharmaceutical promotion, or sharing of misleading information on the internet. With growing demands and expectations of men worried about their wellbeing, there is a real risk of overdiagnosis and unnecessary treatment with testosterone. Suboptimal sampling conditions can lead to misinterpretation of serum biochemistry, and the long-term risks of testosterone therapy for men not having verified hypogonadism may be underestimated by ‘enthusiasts’.

DIAGNOSTIC CHALLENGES

Diagnosis of hypogonadism

Routine screening for hypogonadism in asymptomatic men is not recommended, except in certain conditions (Supplementary Figure S1). Clinical features of hypogonadism are not limited to sexual symptoms — reduced libido, erectile dysfunction (ED), and loss of waking erections. Anaemia, osteoporosis, and vasomotor sweating or flushing are frequently present; indeed, older men may not volunteer sexual symptoms, having ascribed them to ageing.

Sampling conditions

Testosterone secretion has diurnal variation and is suppressed post-prandially, so serum testosterone and sex-hormone binding …

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British Journal of General Practice: 70 (696)
British Journal of General Practice
Vol. 70, Issue 696
July 2020
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How to manage low testosterone level in men: a guide for primary care
Ahmed Al-Sharefi, Scott Wilkes, Channa N Jayasena, Richard Quinton
British Journal of General Practice 2020; 70 (696): 364-365. DOI: 10.3399/bjgp20X710729

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How to manage low testosterone level in men: a guide for primary care
Ahmed Al-Sharefi, Scott Wilkes, Channa N Jayasena, Richard Quinton
British Journal of General Practice 2020; 70 (696): 364-365. DOI: 10.3399/bjgp20X710729
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  • Top
  • Article
    • INTRODUCTION
    • DIAGNOSTIC CHALLENGES
    • PRIMARY, SECONDARY, AND FUNCTIONAL HYPOGONADISM
    • MANAGEMENT GUIDELINES
    • SAFETY OF TESTOSTERONE AND OTHER CONSIDERATIONS
    • WHAT IT MEANS FOR GENERAL PRACTICE
    • SUMMARY
    • Notes
    • Footnotes
    • REFERENCES
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More in this TOC Section

  • Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management
  • The atypical presentation of COVID-19 as gastrointestinal disease: key points for primary care
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