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Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations

The Endocrine Society of Australia commissioned this position statement to update its 2000 guidelines for testosterone prescribing1 and to inform the recommended management of men with androgen deficiency in light of recent regulatory changes to the Pharmaceutical Benefits Scheme.2 Part 1 of this position statement dealt with the assessment of male hypogonadism, including the indications for testosterone therapy.3 This article, Part 2, focuses on treatment and therapeutic considerations for male hypogonadism, particularly considering the ongoing debate about the risk of cardiovascular events related to testosterone treatment.4 The methods used to develop the position statement are detailed in Part 1.3


Cardiovascular events

The current evidence regarding testosterone treatment and cardiovascular outcomes is contradictory and inconclusive.4 There have been no adequately powered randomised controlled trials (RCTs) of testosterone treatment with cardiovascular events as a pre-specified outcome. One RCT has shown an increase in cardiovascular events with testosterone treatment in older men with mobility limitations, many of whom had diabetes or pre-existing cardiovascular disease.5 However,…