Recommendations

Australasian Chapter of Sexual Health Medicine

Recommendations from the Australasian Chapter of Sexual Health Medicine on herpes, chlamydia, candidiasis, ureaplasma & gonorrhoea. The Australasian Chapter of Sexual Health Medicine (AChSHM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Sexual Health Medicine Fellows and trainees in Australia and New Zealand.

5.
Do not prescribe testosterone therapy to older men except in confirmed cases of hypogonadism

Hypogonadism justifying testosterone therapy regardless of age is confirmed based on measurement of circulating testosterone, luteinising hormone (LH) and follicle-stimulating hormone (FSH) concentrations. There is limited high-quality evidence to justify testosterone treatment in older men, usually with chronic disease, who have low circulating testosterone levels but without confirmed pathological hypogonadism, whether due to hypothalamic, pituitary or testicular disease. Moreover, excess cardiovascular events have been associated with testosterone treatment of older men without pathological hypogonadism. While the evidence on these side effects is mixed and additional studies are needed to clarify whether testosterone therapy increases cardiovascular risk, this provides an added reason to restrict the prescription of testosterone therapy to confirmed cases of hypogonadism.

Supporting evidence

Calof OM, Singh AB, Lee ML, et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60(11):1451-7.
Corona G, Maseroli E, Rastrelli G, et al. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf. 2014;13(10):1327-5
Finkle WD, Greenland S2, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014 29;9(1):e85805
Xu L, Freeman G, Cowling BJ, Schooling CM. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med. 2013 Apr 18;11:108.
Yeap BB, Grossmann M, McLachlan RI, et al. Endocrine Society of Australia position statement on male hypogonadism (part 1): assessment and indications for testosterone therapy. Med J Aust. 2016;15;205:173-8.
Yeap BB, Grossmann M, McLachlan RI, et al.Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations. Med J Aust. 2016;205:228-31.

How this list was made

With the assistance of the Royal Australasian College of Physicians as part of Evolve, the Australasian Chapter of Sexual Health Medicine (AChSHM) Council produced and distributed to its membership an online survey. The survey listed 5 examples of clinical practices in sexual health medicine which may be overused, inappropriate or of limited effectiveness in a given clinical context.

Members were asked to comment on these examples and to suggest other low-value practices which may be a sizeable issue in the specialty. Based on the feedback, 8 items were identified for further investigation by AChSHM Council through an evidence review. This resulted in the final list of 5 recommendations which were endorsed by the Council on 15 December 2016.

In July 2018 the Australasian Chapter of Sexual Health Medicine undertook a review of their Top-5 recommendations. Due to changes in evidence, and physician support, recommendation 5 was replaced. The removed recommendation read: “Reconsider the use of nucleic acid amplification testing for gonorrhoea in low-prevalence (i.e. <1% prevalence) populations and people who do not belong to a higher risk group.”

Download AChSHM Recommendations