Don’t prescribe testosterone therapy unless there is evidence of proven testosterone deficiency.
Many of the symptoms attributed to male hypogonadism are commonly seen in normal male aging or in the presence of comorbid conditions. Testosterone therapy has the potential for serious side effects and represents a significant expense. It is therefore important to confirm the clinical suspicion of hypogonadism with biochemical testing. Current guidelines recommend the use of a total testosterone level obtained in the morning. A low level should be confirmed on a different day, again measuring the total testosterone. In some situations, for example conditions in which sex hormone-binding globulin concentrations are altered, a calculated free or bioavailable testosterone may be of additional value.
- Corona G. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf 2014;13:1327-51.
- Finkle WD. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One 2014;9(1):e85805.
- Baillargeon J. Risk of myocardial infarction in older men receiving testosterone therapy. The Annals of Pharmacotherapy 2014;48:1138-44.
- Vigen R. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels, JAMA 2013;310(17):1829-36.
- Xu L. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Medicine 2013;11:108.
- Shores MM. Testosterone treatment and mortality in men with low testosterone levels. Journal of Clinical Endocrinology Metabolism 2012;97:2050-8.
- Bhasin S. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology Metabolism 2010;95:2536-59.
- Fernández-Balsells MM. Clinical review 1: Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis, Journal of Clinical Endocrinology Metabolism 2010;95(6):2560-75.
The Medical Affairs sub-committee of the Endocrine Society of Australia (ESA) collaborated with the Royal Australasian College of Physicians (RACP) to compile a list of 44 possible low-value interventions using desktop research.
The list was examined and refined down to 8 interventions: comprising 6 that were deemed sufficiently common or important to warrant consideration and two additional practices identified by the committee. A review of the evidence for these 8 was completed and circulated to the whole ESA membership for feedback via an on-line survey. Based on the results of the survey, which attracted 146 respondents, a top 5 was identified.
- 1 Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.
- 2 Don’t prescribe testosterone therapy unless there is evidence of proven testosterone deficiency.
- 3 Do not measure insulin concentration in the fasting state or during an oral glucose tolerance test to assess insulin sensitivity.
- 4 Avoid multiple daily glucose self-monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycaemia.
- 5 Don’t order a total or free T3 level when assessing thyroxine dose in hypothyroid patients.