What is age-related low testosterone?

Testosterone is a male hormone. It plays a key role in male sexual and physical health. As men age, the amount of testosterone in their body slowly decreases. This condition is referred to as “age-related low testosterone.” When men have low testosterone, they may have symptoms, such as little or no interest in sex, erectile dysfunction, less energy/feeling weak, mood changes and feeling depressed, loss of bone mineral density, and loss of body and facial hair. It is not clear whether these symptoms are truly associated with low testosterone or if they are a result of other factors, such as chronic illness or certain medications.

Who developed these recommendations?

The American College of Physicians (ACP) developed these guidelines. The ACP is a professional organization for internal medicine doctors, who specialize in health care for adults.

How did the ACP develop these guidelines?

The ACP Clinical Guidelines Committee looked at the best available evidence on adult men with age-related low testosterone who received testosterone replacement therapy (TRT), as well as the outcomes of treatment, including patient values and preferences related to testosterone treatment. The guidelines do not address screening or diagnosing hypogonadism, or monitoring testosterone levels.

What are the benefits and harms of TRT?

Men with age-related low testosterone who receive TRT may show small improvement in sexual function and quality of life. However, evidence shows little or no benefits for common complaints of aging, such as less energy, vitality, physical function, and cognition. Harms from TRT, such as its effect on heart health, prostate cancer, or mortality, are difficult to judge because the available information is limited. In addition, the long-term benefits and harms of testosterone treatment are unknown, because most studies followed patients for only 12 months or less.

What does the ACP recommend that patients and doctors do?

Doctors and patients discuss whether to begin TRT in men with age-related low testosterone who want to improve sexual function. The discussion should include the potential benefits and harms of treatment, costs, and patient preferences. Doctors should reevaluate patients' symptoms within 12 months, and periodically thereafter. Testosterone replacement therapy should be stopped in men with age-related low testosterone with sexual dysfunction who do not see an improvement. Doctors should consider offering an intramuscular injection rather than transdermal formulations of testosterone (patches, creams, pellets) when beginning TRT to improve sexual function in men with age-related low testosterone. Costs are considerably lower for intramuscular injections, and the effectiveness and harms are similar to those of transdermal formulations.

Questions for your doctor

• Will taking TRT help with the symptoms that I came to discuss with you?

• What method of TRT is best for me?

• What are the risks and side effects of treatment?

• How long will it take for TRT to work, and what if it does not work?

中文翻译：

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成年男性与年龄相关的低睾丸激素治疗。

什么是与年龄有关的低睾丸激素？

睾丸激素是一种男性激素。它在男性性健康和身体健康中起关键作用。随着男性年龄的增长，体内的睾丸激素含量会缓慢下降。这种情况被称为“与年龄有关的低睾丸激素”。当男性的睾丸激素水平低时，他们可能会出现一些症状，例如对性生活几乎没有兴趣，勃起功能障碍，精力/感觉虚弱，情绪变化和感到沮丧，骨矿物质密度降低以及身体和面部毛发丧失。目前尚不清楚这些症状是否确实与睾丸激素水平低有关，或者是否是其他因素（例如慢性疾病或某些药物）的结果。

谁提出了这些建议？

美国医师学院（ACP）制定了这些指南。ACP是专门为成人提供医疗服务的内科医生的专业组织。

ACP如何制定这些准则？

ACP临床指南委员会研究了与年龄相关的睾丸激素水平低的成年男性接受睾丸激素替代疗法（TRT）的最佳可用证据，以及治疗结果，包括患者价值和与睾丸激素治疗相关的偏爱。该指南不涉及筛查或诊断性腺功能低下或监测睾丸激素水平。

TRT有哪些利弊？

接受TRT的与年龄相关的睾丸激素水平低下的男性，其性功能和生活质量可能会略有改善。但是，证据表明，对于衰老的常见抱怨很少或没有好处，例如精力，活力，身体机能和认知能力下降。由于可用信息有限，因此难以判断TRT对心脏健康，前列腺癌或死亡率的危害。此外，睾丸激素治疗的长期利弊是未知的，因为大多数研究仅对患者进行了12个月或更短的随访。

ACP建议患者和医生做什么？

医生和患者讨论了是否在想要改善性功能的年龄相关性低睾丸激素男性中开始进行TRT。讨论应包括治疗的潜在利弊，成本和患者喜好。医生应在12个月内重新评估患者的症状，此后定期评估。对于年龄相关的性功能低下睾丸激素水平低，且未见改善的男性，应停止睾丸激素替代治疗。开始TRT时，医生应考虑肌肉注射而不是经皮睾丸激素制剂（贴剂，乳膏，小丸），以改善与年龄相关的睾丸激素水平低的男性的性功能。肌内注射的成本大大降低，其有效性和危害与经皮制剂相似。

给医生的问题

•服用TRT是否可以帮助我与您讨论的症状？

•哪种TRT方法最适合我？

•治疗的风险和副作用是什么？

•TRT需要多长时间才能工作，如果不起作用怎么办？