A Critique of the AUA Guidelines on Testosterone Deficiency
The publication of the first American Urological Association (AUA) guidelines regarding the evaluation and management of testosterone deficiency (TD) in 2018 (“Guidelines”) was a landmark event, serving to recognize the importance of this condition for US urologists.1 Urologists play an outsized role in the treatment of men with TD because presenting symptoms are usually sexual. Urologists also have nearly 80 years of experience observing the effects of androgen deprivation.
Morgentaler A, Traish AM, Khera M. A Critique of the AUA Guidelines on Testosterone Deficiency. The Journal of Sexual Medicine. Redirecting
The AUA Guidelines for evaluation and management of men with TD are an important step forward for US urologists and our patients. These recommendations represent a useful playbook for novice and somewhat experienced clinicians to identify and manage men with TD. As with all guidelines, these recommendations are of less use to experts and specialists, who incorporate invaluable experience as well as additional clinical and research information in their decision making. We were particularly gratified to note the recognition in the Guidelines that TTh may be reasonably offered to some men with prostate cancer.
Our greatest area of disagreement is with the overly conservative diagnostic threshold of 300 ng/dL. This threshold is not followed by most experienced clinicians, and its application will result in many men suffering from classic symptoms of TD being denied treatment. We hope this threshold value will be liberalized in future Guidelines. We also believe that free testosterone plays an important role in diagnosing TD, and we encourage ordering this test as well as SHBG to evaluate the man presenting with symptoms suggestive of TD.
The publication of the first American Urological Association (AUA) guidelines regarding the evaluation and management of testosterone deficiency (TD) in 2018 (“Guidelines”) was a landmark event, serving to recognize the importance of this condition for US urologists.1 Urologists play an outsized role in the treatment of men with TD because presenting symptoms are usually sexual. Urologists also have nearly 80 years of experience observing the effects of androgen deprivation.
Morgentaler A, Traish AM, Khera M. A Critique of the AUA Guidelines on Testosterone Deficiency. The Journal of Sexual Medicine. Redirecting
The AUA Guidelines for evaluation and management of men with TD are an important step forward for US urologists and our patients. These recommendations represent a useful playbook for novice and somewhat experienced clinicians to identify and manage men with TD. As with all guidelines, these recommendations are of less use to experts and specialists, who incorporate invaluable experience as well as additional clinical and research information in their decision making. We were particularly gratified to note the recognition in the Guidelines that TTh may be reasonably offered to some men with prostate cancer.
Our greatest area of disagreement is with the overly conservative diagnostic threshold of 300 ng/dL. This threshold is not followed by most experienced clinicians, and its application will result in many men suffering from classic symptoms of TD being denied treatment. We hope this threshold value will be liberalized in future Guidelines. We also believe that free testosterone plays an important role in diagnosing TD, and we encourage ordering this test as well as SHBG to evaluate the man presenting with symptoms suggestive of TD.
