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Endocrine Society of Australia position statement on male hypogonadism (part 1): assessment and indications for testosterone therapy

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The Endocrine Society of Australia formulated guidelines for testosterone prescribing in 2000, aiming to restrict inappropriate usage.1 Since then, prescriptions of testosterone have risen dramatically in Australia and elsewhere without any new proven indications, consistent with its use extending beyond the treatment of men with pathological hypogonadism due to pituitary or testicular disease.24 Controversy has arisen over the role of testosterone treatment in older men with medical comorbidities who have low levels of circulating testosterone, in the absence of hypothalamic, pituitary or testicular disease.5 There are gaps in the evidence base in relation to the potential benefits of testosterone treatment in men with obesity or type 2 diabetes and those receiving long term glucocorticoid or opioid therapy, who may exhibit low levels of circulating testosterone. There is also ongoing debate about the risk of cardiovascular adverse events related to testosterone treatment.6 In view of the rising rates of testosterone prescription, in 2015 the Australian Government tightened the criteria for which testosterone therapy would be subsidised in the absence of pathological hypogonadism.7 In this context, the Endocrine Society of Australia commissioned…