Treatment

• Initiating Treatment
  • Nebido®
  • Testogel®
• Monitoring
• Safety

Treatment

Monitoring

The  international medical societies European Association of Urology (EAU), International   Society   for   the   Study  of  the  Aging  Male  (ISSAM), International  Society  of  Andrology  (ISA)  issued recommendations on the definition,  investigation,  treatment and follow-up of men with late-onset hypogonadism.

Testosterone  administration  does  not cause prostatic carcinoma. However, prostatic  carcinoma  is  a  sexual hormone-dependent tumor and therefore a pre-existing tumor  may  be  stimulated  to further growth. Any testosterone product  is  thus  strictly  contraindicated  in  patients  with  diagnosed prostatic carcinoma. Digital  rectal  examination  and determination of PSA levels are mandatory according  to  ISSAM, EAU and ISA recommendations in men over the age of 45 years as baseline measurements of prostate health.¹

The recommendations of International Society of the Study of the Aging Male (ISSAM), European Association of Urology (EAU) and International Society of Andrology (ISA) on investigation, treatment and monitoring of late-onset hypogonadism in Males recommend the following periodical check-ups during testosterone therapy.¹

• prior to therapy with testosterone,
• at quarterly intervals for the first 12 months,
• yearly thereafter.

Additionally, ISSAM, ISA and EAU have given the following recommendations for monitoring of patients under testosterone treatment:

• Polycythemia occasionally develops during testosterone treatment. Therefore, periodic hematological assessment is indicated, i.e. before treatment, 3-monthly for one year and then annually. Dose adjustments may be necessary in case of elevated hematocrit and/or hemoglobin. The number of red blood cells also provides information about an anemia, which is a symptom of testosterone deficiency. Anemia may improve rapidly under testosterone treatment so that the red blood cell count is a good marker of the success of therapy. The contrary, a too high count of red blood cells, must be monitored as well.
• Improvement in signs and symptoms of testosterone deficiency should be sought and failure to benefit clinical manifestations should result in discontinuation of treatment. Further investigation for other causes is then mandatory.
• Testosterone normally results in improvements in mood and well-being. The development of negative behavioral patterns during treatment calls for dose modifications or discontinuation of therapy.
• Bone density increases under testosterone substitution and fracture rates may be reduced. Therefore assessment of bone density at two-year intervals
  may be advisable (if available and affordable).

Reference:
1. Nieschlag E, Swerdloff R, Behre HM, Gooren L, Kaufman JM, Legros JJ, Lunenfeld B, Morley J,  Schulman  C,  Wang  C,  Weidner  W,  Wu F: Investigation, Treatment and Monitoring   of  Late-Onset  Hypogonadism  in  Males–ISA,  ISSAM,  and  EAU Recommendations. Europ Urol 2005; 48: 1–4.

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