Testosterone treatment in adults with age-related low testosterone: ACP guidelines
American College of Physicians has issued a guideline for testosterone treatment in adult men with age-related low testosterone. ACP's recommendations include treating for sexual dysfunction only, discontinuing treatment if a sexual function does not improve, and not initiating treatment for other reasons.The guidelines are based on 38 randomized controlled trials
Physicians should prescribe testosterone for men with age-related low testosterone only to treat sexual dysfunction, the American College of Physicians (ACP) says in a new evidence-based clinical practice guideline. The evidence shows that men with age-related low testosterone may experience slight improvements in sexual and erectile function. The guideline has been published in Annals of Internal Medicine.
ACP suggests that physicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function because the costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar. The annual cost in 2016 per beneficiary for testosterone replacement therapy was $2,135.32 for transdermal and $156.24 for the intramuscular formulation according to paid pharmaceutical claims provided in the 2016 Medicare Part D Drug Claims data. Most men are able to inject the intramuscular formulation at home and do not require a separate clinic or office visit for administration.
Main recommendations are-
- Physicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function as it is more cost effective.
- Physicians should discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual and erectile function based on the potential benefits, harms, costs, and patient preferences.
- Physicians should reevaluate symptoms within 12 months and periodically thereafter and discontinue testosterone treatment if the sexual function does not improve.
- Testosterone treatment should not be initiated to improve energy, vitality, physical function, or cognition because the evidence indicates testosterone treatment is not effective.
ACP's guideline, endorsed by the American Academy of Family Physicians, applies to adult men with age-related low testosterone. It does not address screening or diagnosis of hypogonadism or monitoring of testosterone levels.
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