International Journal of Urology and Nephrology

International Journal of Urology and Nephrology ISSN: 2756-3855 Vol. 10 (9), pp. 001-021, September, 2022. © International Scholars Journals


How and When to Evaluate Testosterone Deficiency: Controversies and Consensus Among Specialties Worldwide

AUTHORS: Sara Q. Perkins1, David Fumo2 MD, Puneet Sindhwani2 MD.


The worldwide prevalence of testosterone deficiency (TD) is increasing due to an aging population. However there is discrepancy surrounding its diagnosis, both between countries and major specialty societies. The purpose of this review is to compare and contrastcurrent guidelines across the world to assess variability in the diagnosis and evaluation of TD. There were no available guidelines from Asian, African or South American specialty societies in English language literature. Guidelines from Canada, Europe, and the United States, including the American Association of Clinical Endocrinologists (AACE) the American Urologic Association (AUA), and the Endocrine Society are evaluated. A literature search was performed using Pubmed, Uroweb, the AUA and AACE websites to evaluate the most recent guidelines on hypogonadism. Guidelines and the level of evidence supporting these are compiled in Tables. All guidelines concurred that testosterone replacement therapy (TRT) is indicated in patients with symptoms of hypogonadism in combination with biochemically low testosterone but there was no consensus with respect to the cut off -value for low testosterone,diagnostic methodology, preferred assays or screening at risk populations.  This highlights the differences in world health care delivery in the evaluation and treatment of TD and need for further research to build a consensus usingbest available evidence. This article provides the most updated and concise review of the controversies and consensus in the diagnosis and evaluation of TD.