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© The Canadian Journal of Urology™; 23(Supplement 1); February 2016
Testosterone deficiency syndrome:
benefits, risks, and realities associated
with testosterone replacement therapy
Jacob Hassan, MD,
1
Jack Barkin, MD
2
1
Division of Urology, Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada
2
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
HASSAN J, BARKIN J. Testosterone deficiency
syndrome: benefits, risks, and realities associated
with testosterone replacement therapy.
Can J Urol
2016;23(Suppl 1):20-30.
Testosterone deficiency syndrome, which has sometimes
been termed age-related or late-onset hypogonadism, is a
syndrome characterized by both clinical manifestations
as well as a biochemical deficiency of testosterone. This
condition is associated with considerable morbidity and
mortality, accounting for billions of dollars in health care
costs. There is some evidence that suggests that restoring
testosterone levels in these individuals may help to
manage or delay progression of the associated morbidities.
Furthermore, despite controversies in the literature and
media, testosterone replacement has proven to be quite
safe in most men with minimal if any adverse effects when
dosing to achieve the eugonadal range. It is nevertheless
very important for clinicians to be aware of the possible
risks and contraindications of treatment to ensure proper
patient selection and appropriate monitoring.
Key Words:
testosterone deficiency syndrome,
hypogonadism, testosterone replacement therapy
recent Canadian Clinical Practice Guidelines
1
is often
age-related hypogonadism where testosterone levels
are low, but the normal physiologic feedback pathway
has been lost as demonstrated by the fact that FSH and
LH levels are not elevated.
There are various clinical manifestations of
hypogonadism, as shown in Table 1. While these signs
and symptoms are characteristic of hypogonadal men,
they are by no means specific, and thus biochemical
parameters are necessary to establish a diagnosis.
It has been estimated that the crude Canadian
prevalence of biochemical testosterone deficiency is
25%amongmen aged 40 to 62 years.
2
Alarger US-based
biochemical prevalence study, the Hypogonadism in
Males (HIM) study, estimated that 39% of men aged
45 and above are testosterone deficient based on a
total testosterone cut off of 300 ng/dL.
3
Far fewer
men, however, are symptomatic and thus they are not
20
Introduction
Male hypogonadism is a clinical syndrome caused
by androgen deficiency, which may adversely affect
multiple organ functions and quality of life. It is
due to the disruption of one or several levels of the
hypothalamic-pituitary-gonadal axis and canbe broadly
classified, based on the level of disturbance, as either
primary (testicular failure: biochemically associated
with high gonadotropins- follicle-stimulating hormone
(FSH) and luteinizing hormone (LH)), secondary
(hypothalamic and/or pituitary failure: low FSH and
LH, or mixed (combination of primary and secondary).
Testosterone deficiency syndrome as it is termed in the
Address correspondence to Dr. Jacob Hassan, Credit Valley
Hospital, Trillium Health Partners, 2200 Eglinton Avenue
West , Mississauga, ON L5M 2N1 Canada