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- How to manage low testosterone level in men: a guide for primary careWe write on behalf of the British Society for Sexual Medicine to express our concerns over the above “clinical intelligence” or “guide” for general practitioners on male hypogonadism and the accompanying management algorithm. We are concerned that this terminology made lead to GPs interpreting the article as being a peer reviewed guideline rather than personal opinion. Unfortunately, the authors state that there are UK guidelines in place for erectile dysfunction, referencing a guideline of fertility and a NHS clinical knowledge summary Aug 2019, which comes with a disclaimer that it is NOT a NICE guideline. In fact, this NHS CKS states that is almost exclusively based on the comprehensive peer reviewed BSSM guidelines 2018,1 omitted by the authors, who chose to reference Australian guidelines instead. The guidelines of the American Urology Association state that “patients need to be informed that low testosterone is an independent risk factor for cardiovascular disease”.2Whilst we could dissect many points in the article that are not referenced and represent personal opinion, we believe that the findings from 2 pivotal trials should lead the authors reconsider their advice. Firstly, the recent T4DM RCT3 involving 1007 obese men with hypogonadism studied for 2 years, presented at American Diabetes Association 2020, clearly showed that TRT reduces progressi...Show MoreCompeting Interests: None declared.
- How to manage low testosterone level in men: a guide for primary careAl-Sharefi et al1 correctly identify that there is currently some debate about the correct monitoring of testosterone replacement therapy in primary care.In comparison to the many drug monitoring activities carried out to high standards in General Practice, such as rheumatological DMARD immunosuppressives, or therapies linked to the QOF domains like levothyroxine, there may be under-performance in the monitoring of testosterone replacement therapy (TRT). As is the case for many long-term conditions in primary care, practice nurses and clinical pharmacists could become more involved in this.In a preliminary study2 that we performed in two typical practices in the East of England, it was clear that patients were not consistently receiving the recommended annual monitoring, in particular PSA testing and digital rectal examination (DRE).There are multiple reasons for this, including the disparity between the different international guidelines and the absence of a UK consensus. The patients are often unaware, as the leaflets inside their medication do not highlight monitoring requirements. When patients are discharged from endocrinology or urology clinics for follow-up by general practitioners, the communication of explicit guidance on the requisite monitoring would be helpful to both doctor and patient.Further work is needed to set agree...Show MoreCompeting Interests: None declared.