Asking about history to explain low testosterone levels is an often overlooked part of patient evaluation. Two known causes of low testosterone in men often are not part of history taking but should be. One is use of opioids. The other is withdrawal from anabolic steroids. The best way to root these out in a history is to ask about any recent surgery and use of anabolic steroids, said Dr. Bhasin, speaking at the annual meeting of the Endocrine Society.
When it works, testosterone can make some men feel better: Testosterone replacement was associated with increased libido, erectile function, and sexual activity. However, testosterone replacement had no effect on energy and/or mood.
Not every man over the age of 65 with low testosterone is a candidate for testosterone replacement. There are some risks associated with its use; PSA may rise within 6 months of starting testosterone replacement, leaving physicians and men facing the issue of whether to have a prostate biopsy. The guideline recommends evaluating the patients with PSA the first time within 3-12 months after the start of therapy. When the test shows that PSA has risen, the decision of whether to have a prostate biopsy is one that should be shared by the patient and physician.
Dr. Bhasin declared financing from the National Institute on Aging, the National Institute of Nursing Research, the Patient-Centered Outcomes Research Institute, AbbVie, Metro International Biotechnology, Alivegen, Abbott, Transition Therapeutics, and Function Promoting Therapies.
skubetin@frontlinemedcom.com
SOURCE: ENDO 2018