Androgen deficiency affects between 1 in 20 and 1 in 200 men1,2.GPs are typically the first point of contact for men with symptoms of androgen deficiency.
This article outlines what GPs need to know about diagnosing and treating androgen deficiency — including clinical and laboratory assessments, appropriate referrals and ongoing patient management.
What is androgen deficiency?
Androgen deficiency is a syndrome characterised by low testosterone and accompanying signs and symptoms3, 4, 5.
It’s estimated that approximately 5 in 1000 men have androgen deficiency warranting treatment with testosterone6.
A low testosterone level alone does not constitute androgen deficiency7, and neither does the normal age-related decline in testosterone of approximately 1% per year8.
What causes androgen deficiency?
Androgen deficiency is caused by poor testicular function (hypogonadism).
How to diagnose androgen deficiency
Androgen deficiency may have subtle effects on health and wellbeing, which can make diagnosis challenging.
Here’s what to look for in a patient’s medical history, as well as clinical and laboratory examinations and assessments to assist diagnosis.
How to manage patients with androgen deficiency
Testosterone replacement therapy (TRT)
TRT aims to relieve the signs and symptoms of androgen deficiency using convenient and effective (intramuscular or transdermal) testosterone preparations14.
Monitoring TRT
Alleviating a patient’s leading symptom is the best clinical measure of effective management.
Blood sampling for serum testosterone, LH and FSH measurement should be timed to allow estimation of steady-state testosterone levels. This is feasible by sampling during the trough (immediately before next dose) for men using injectable and transdermal preparations. Timing the sampling for accurate measurement in men taking oral testosterone is more difficult.
Random sampling of blood for measurement of serum testosterone, without consideration of dosage timing, is effectively useless.
