Page 3 - Remedial Andrology

TABLE OF CONTENTS PAGE

1. INTRODUCTION 10
1.1 Aims and Objectives 10
1.2 Panel composition 10
1.3 Available Publications 10
1.4 Publication History 10
1.5 Changes in the Guideline for 2021 10

2. METHODOLOGY 10
2.1 Methods 10
2.2 Review 11
2.3 Future goals 11

3. MALE HYPOGONADISM 11
3.1 Epidemiology and prevalence of male hypogonadism 11
3.1.1 Body Composition and Metabolic Profile 11
3.1.2 Metabolic Syndrome/Type 2 Diabetes 12
3.2 Physiology of testosterone production 12
3.2.1 Circulation and transport of testosterone 13
3.2.2 Androgen receptor 14
3.3 Role of testosterone in male sexual and reproductive health 14
3.3.1 Sexual development and maturation 14
3.3.2 Sexual function 14
3.4 Classification and causes of male hypogonadism 15
3.5 Late-onset hypogonadism 17
3.5.1 Diagnostic evaluation 17
3.5.2 History taking 20
3.5.3 Physical examination 20
3.5.4 Summary of evidence and recommendations for the diagnostic evaluation of
LOH 20
3.5.5 Recommendations for screening men with LOH 21
3.6 Treatment of LOH 21
3.6.1 Indications and contraindications for treatment of LOH 21
3.6.2 Testosterone therapy outcomes 22
3.6.2.1 Sexual dysfunction 22
3.6.2.2 Body composition and metabolic profile 22
3.6.2.3 Mood and cognition 22
3.6.2.4 Bone 23
3.6.2.5 Vitality and physical strength 23
3.6.2.6 Summary of evidence and recommendations for testosterone
therapy outcome 23
3.6.3 Choice of treatment 24
3.6.3.1 Lifestyle factors 24
3.6.3.2 Medical preparations 24
3.6.3.2.1 Oral formulations 24
3.6.3.2.2 Parenteral formulations 25
3.6.3.2.3 Transdermal testosterone preparations 25
3.6.3.2.4 Transmucosal formulations 25
3.6.3.2.4.1 Transbuccal Testosterone preparations 25
3.6.3.2.4.2 Transnasal testosterone preparations 25
3.6.3.2.5 Subdermal depots 25
3.6.3.2.6 Anti-oestrogens 25
3.6.3.2.7 Gonadotropins 26
3.6.3.3 Summary of evidence and recommendations for choice of treatment
for LOH 28
3.7 Safety and follow-up in hypogonadism management 28
3.7.1 Hypogonadism and fertility issues 28
3.7.2 Male breast cancer 28
3.7.3 Lower urinary tract symptoms/benign prostatic hyperplasia 28

2 SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021