This includes discussing any previous treatments, surgeries, or medications you have taken. By analyzing these results, healthcare professionals can identify any hormonal imbalances or abnormalities that may impact the effectiveness or safety of HCG therapy. This comprehensive evaluation allows the healthcare professional to have a complete picture of your health status and determine if HCG therapy is appropriate for you. It is crucial to discuss any pre-existing medical conditions with a healthcare professional before considering HCG therapy. While self-administration may offer convenience and cost-effectiveness, it is crucial to receive proper training and guidance to ensure correct technique and minimize the risk of complications.
Testosterone deficiency is defined as testosterone blood levels less than 300 nanograms per deciliter (ng/dL) along with symptoms of low testosterone. Although the study was not powered to detect cardiovascular events as a primary endpoint, the authors did not detect increased risk in the testosterone group. Individual pellets consist of 75 mg of testosterone and may be combined to deliver variable doses of testosterone therapy.
Similarly, in the event patients have unexplained anemia that improves on testosterone therapy, continuation can be considered even in the absence of other symptom improvement. Two RCTs compared treatment of testosterone deficient males with SERMs versus testosterone versus placebo and found that sperm concentration was maintained (comparable to placebo) for males treated with the SERMs, but was significantly decreased for males on exogenous testosterone.401, 402 Finally, Helo et al. conducted a prospective, double-blind, RCT comparing the SERM clomiphene citrate versus the AI anastrozole in infertile males with testosterone deficiency. One study of 60 patients undergoing long-term therapy of 50 mg methyltestosterone three times a day found that nearly one-third of patients, none of whom had a history of liver disease, returned abnormal liver function tests and/or liver scans.387 Testosterone undecanoate is an oral testosterone analogue that is absorbed via the intestinal lymphatics allowing it to avoid the first pass liver effect.
The Panel explicitly uses the term testosterone therapy rather than testosterone replacement therapy or testosterone supplementation to be in keeping with the beliefs of the current thought leaders in the field. Ultimately, the AUA and the Testosterone Panel were committed to creating a Guideline that ensures that men in need of testosterone therapy are treated effectively and safely. The explosion in the use of testosterone in the past decade is multifactorial in its etiology, including the increased use of direct-to-consumer advertising, which has resulted in greater patient knowledge and demand; relaxation of the indications for testosterone prescribing by clinicians; and the establishment of clinical care centers devoted to men's health, testosterone treatment, and anti-aging strategies. Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. All men with testosterone deficiency should be counseled regarding lifestyle modifications as a treatment strategy. PSA should be measured in men over 40 years of age prior to commencement of testosterone therapy to exclude a prostate cancer diagnosis.
It is the opinion of this Panel that total testosterone should be tested after the commencement of therapy at a time point that allows a patient to be sufficiently established on a dosing regimen before determining if therapeutic levels have been achieved and if dosing alterations are required. Studies that randomized overweight or obese men to diet and exercise programs had significantly greater increases in total testosterone levels than men who underwent calorie reduction or exercise programs alone.378, 379 It is also postulated that men who engage in quantitatively more exercise have the greatest increases in serum testosterone from baseline.378 Until there is definitive evidence proving an association between testosterone therapy and subsequent MACE, the Panel recommends that clinicians counsel patients that the current scientific literature does not definitively demonstrate that testosterone therapy increases risk. A study by Pastuszak et al. (2015)355 found a significant increase in biochemical recurrence in high-risk patients who received testosterone therapy after RT or RT/ADT. Currently published studies have not demonstrated an increased risk of biochemical cancer recurrence in post-RP patients who are on testosterone therapy, nor does it define the optimal timing for commencement of testosterone therapy. At the end of the study, serum testosterone levels rose in those men receiving testosterone therapy; however, no rise in testosterone levels were seen within the prostate tissue itself.
Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low) for support of Strong, Moderate, or Conditional Recommendations. The Evaluation and Management of Testosterone Deficiency AUA Guideline provides guidance to the practicing clinician on how to diagnose, treat and monitor the adult male with testosterone deficiency. Contact your healthcare provider if you have questions about your hCG levels or what they mean.