Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Curr Opin Endocrinol Diabetes Obes. 2020 Dec;27(6):397-403. doi: 10.1097/MED.0000000000000581.
The incidence of testosterone deficiency and number of men on testosterone therapy (TTh) has increased significantly over the past 3 decades. This rise has been accompanied by controversies surrounding the indications and possible adverse effects of therapy. To better inform prescribing habits among providers, many major medical associations have devised guidelines regarding the diagnosis and management of testosterone deficiency. While these guidelines agree in many areas, there are some key differences that should be identified. This review will explore the similarities, differences, and rationale for these guidelines.
Over the past 7 years, much attention has been devoted to the implications of TTh on cardiac health. All reviewed guidelines include dedicated sections discussing these implications and the society's position on prescribing testosterone considering recent findings, however, differ on specific contraindications to TTh and when to initiate therapy after a cardiovascular event. In addition, the American College of Physicians released its first guideline earlier this year which may impact prescribing habits among primary care physicians.
The differences between testosterone deficiency guidelines may indicate gaps in our knowledge of testosterone deficiency and focuses of future research efforts. Prescribers should be aware of these differences and discuss all treatment options with their patients.
在过去的 30 年中，睾丸激素缺乏症的发病率和接受睾丸激素治疗（TTh）的男性人数显著增加。这种增加伴随着围绕治疗的适应症和可能的不良反应的争议。为了更好地为提供者提供处方习惯，许多主要医学协会制定了关于睾丸激素缺乏症的诊断和管理的指南。虽然这些指南在许多方面达成了一致，但仍有一些关键的区别需要确定。本综述将探讨这些指南的相似之处、差异和基本原理。
在过去的 7 年中，人们对 TTh 对心脏健康的影响给予了极大的关注。所有审查的指南都包括专门的章节讨论这些影响，以及考虑到最近的发现，社会对开处睾丸激素的立场，然而，在 TTh 的具体禁忌症和在心血管事件后何时开始治疗方面存在差异。此外，美国医师学院今年早些时候发布了其首个指南，这可能会影响初级保健医生的处方习惯。
睾丸激素缺乏症指南之间的差异可能表明我们对睾丸激素缺乏症的认识存在差距，也是未来研究工作的重点。开处方者应该了解这些差异，并与患者讨论所有治疗方案。
