International Journal of Urology and Nephrology

International Journal of Urology and Nephrology ISSN: 2756-3855 Vol. 10 (9), pp. 001-038, September, 2022. © International Scholars Journals

Review Article

Risks, Contraindications and Follow up After Testosterone Replacement Therapy: Lack of Consensus among Specialties and Countries

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


The direct to consumer marketing of the “Is it Low T” movement has resulted in an increase of men >40 years old seeking testing for testosterone deficiency (TD) and treatment with testosterone replacement therapy (TRT). The FDA has mandated that TRT inserts should include warnings about a variety of possible risks such as venous thrombosis,prostate cancer, diabetes, and cardiovascular health risks. In response several societies have issued guidelines to address the use of TRT. The purpose of this review is to evaluate the variability in treatment and monitoring of TD and TRT. A literature search was performed to evaluate the most recent guidelines on TD. There were no available guidelines from Asian, African or South American specialty societies published English language literature. Guidelines from Canada, Europe, and the United States including the American Association of Clinical Endocrinologist (AACE) the American Urologic Association(AUA), and the Endocrine Society are evaluated. Comparisons between guidelines are compiled in Tables and their level of evidence evaluated. All guidelines were in concurrence that a desire to maintain male fertility should be universally considered a contraindication to TRT. While other contraindications and risks associated with TRT such as cardiovascular disease or prostate cancer varied widely. Follow up assessment recommendations such as cardiac, bone density, and digital rectal exam also are non-congruent. The guidelines on TD reflect the lack of consensus between specialty societies, paucity of data, and need for further research on testosterone replacement treatment of TD.