(Published 2018, Reviewed and Validity Confirmed 2024)

Testosterone testing and prescriptions have nearly tripled in recent years; however, it is clear from clinical practice that there are many men using testosterone without a clear indication. Given the clinical and commercial testosterone landscape, this Guidelines was developed as an evidence-based document to inform clinicians on the proper assessment and management of patients with testosterone deficiency. The goal of this Guideline is to ensure that patients in need of testosterone therapy are treated effectively and safely.

Testosterone deficiency does not imply simply a state of low testosterone production, but rather to be testosterone deficient is to have low testosterone levels combined with symptoms or signs that are associated with low serum total testosterone. Thus, a patient is considered testosterone deficient and a candidate for testosterone therapy only when they meet both criteria. The challenge for clinicians is that the symptoms that have been associated with low testosterone levels are very non-specific and can be manifestations of other conditions (e.g., chronic fatigue, chronic stress, a depressed state). To guide clinicians in the management of testosterone deficiency, this Guidelines covers the following topics:

• Diagnosis of testosterone deficiency
• Adjunctive testing
• Counseling regarding treatment of testosterone deficiency
• Treatment of testosterone deficiency
• Follow-up of patients on testosterone therapy