• Amir Qaseem, Carrie A Horwitch, Sandeep Vijan, Itziar Etxeandia-Ikobaltzeta, Devan Kansagara, Clinical Guidelines Committee of the American College of Physicians, Mary Ann Forciea, Carolyn Crandall, Nick Fitterman, Lauri A Hicks, Jennifer S Lin, Michael Maroto, Robert M McLean, Reem A Mustafa, and Janice Tufte.
• American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.).
• Ann. Intern. Med. 2020 Jan 21; 172 (2): 126133126-133.

DescriptionThe American College of Physicians (ACP) developed this guideline to provide clinical recommendations based on the current evidence of the benefits and harms of testosterone treatment in adult men with age-related low testosterone. This guideline is endorsed by the American Academy of Family Physicians.MethodsThe ACP Clinical Guidelines Committee based these recommendations on a systematic review on the efficacy and safety of testosterone treatment in adult men with age-related low testosterone. Clinical outcomes were evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system and included sexual function, physical function, quality of life, energy and vitality, depression, cognition, serious adverse events, major adverse cardiovascular events, and other adverse events.Target Audience And Patient PopulationThe target audience includes all clinicians, and the target patient population includes adult men with age-related low testosterone.Recommendation 1 AACP suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function (conditional recommendation; low-certainty evidence). The discussion should include the potential benefits, harms, costs, and patient's preferences.Recommendation 1 BACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter. Clinicians should discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function (conditional recommendation; low-certainty evidence).Recommendation 1 CACP suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar.Recommendation 2ACP suggests that clinicians not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition (conditional recommendation; low-certainty evidence).

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