Indications for testosterone therapy in men.

Purpose of review: Testosterone replacement therapy for men with organic hypogonadism due to medical disease of the hypothalamic-pituitary-testicular (HPT) axis is uncontroversial. In these men, testosterone replacement replaces the deficient hormone and relieves the signs and symptoms of androgen deficiency. In contrast, the role of testosterone treatment in middle-aged or older men who have clinical features consistent with androgen deficiency accompanied by reductions in serum testosterone but lack identifiable HPT axis disease, a scenario sometimes referred to as 'functional' or 'late onset' hypogonadism, has been uncertain.

Recent findings: Three large randomized controlled clinical trials, discussed in this review, have reported new data regarding short-term to medium-term benefits and risks of testosterone therapy in such middle-aged and older men, including effects on sexual function, vitality, cognition and mood, glucose metabolism, physical function, hematologic parameters, as well as bone, cardiovascular and prostate health.

Summary: The findings of these trials allow for a more nuanced, personalized approach to testosterone therapy in such men. However, long-term benefits and risk of testosterone therapy (beyond 3-4 years) remain unknown.