Clinical Practice Guideline

Testosterone Therapy for Hypogonadism Guideline Resources

March 19, 2018

Full Guideline: Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline
JCEM | March 2018

Shalender Bhasin, Juan P. Brito, Glenn R. Cunningham, Frances J. Hayes, Howard N. Hodis, Alvin M. Matsumoto, Peter J. Snyder, Ronald S. Swerdloff, Frederick C. Wu, Maria A. Yialamas

Differences between the 2010 and 2018 guidelines:

  • More rigorous appraisal of testosterone’s efficacy and safety using RCTs published during the last three years.
  • Points out continuing uncertainty about the benefits and risks of testosterone therapy as well as suboptimal testosterone prescribing practices.
  • Highlights the importance of an appropriate diagnostic work up and monitoring plan.

Diagnosis and Treatment of Male Hypogonadism | ENDO 2018



Essential Points

  • Recommends making a diagnosis of hypogonadism only in men with symptoms and signs consistent with testosterone (T) deficiency and unequivocally and consistently low serum T concentrations.
  • Recommends the use of accurate assays for the measurement of total and free testosterone and rigorously derived reference ranges for the interpretation of testosterone levels.
  • Recommend confirming the diagnosis by repeating the measurement of morning fasting total T concentrations.
  • In men determined to have androgen deficiency, we recommend additional diagnostic evaluation to ascertain the cause of androgen deficiency.
  • We recommend against starting T therapy in patients who are planning fertility in the near term or have any of a number of specified conditions.

Summary of Recommendations

+1.0 Diagnosis of Hypogonadism in Men

+2.0 Treatment of Hypogonadism with Testosterone

+3.0 Monitoring of Testosterone Replacement Therapy

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