Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)
Mohit Khera, Luiz Otávio Torres, Ethan D. Grober, Abraham Morgentaler, Martin Miner, T. Hugh Jones, Jesse N. Mills, Andrea Salonia
Abstract
INTRODUCTION: Male hypogonadism is a clinical condition combining low circulating testosterone (T) and specific signs and symptoms associated with impaired hormone production. OBJECTIVES: To provide the 5th International Consultation for Sexual Medicine consensus paper with recommendations concerning management strategies for hypogonadism. OUTCOMES: A narrative review combined with expert opinions on major topics concerning diagnosis of male hypogonadism; treatment options; T impact toward cardiovascular, metabolic, sexual, and reproductive health; and prostate cancer (PCa). METHODS: A consensus panel was held with leading Sexual Medicine experts during the 5th ICSM. Relevant English-language peer-reviewed literature was reviewed with a focus on research from but not limited to the last 10 years. The quality of each individual study was judged with Oxford levels of evidence (LOEs) criteria, but overall LOEs were not used as a systematic review was not performed. The expert panel generated recommendations based on the quality of evidence and criteria of Grading of Recommendations Assessment, Development and Evaluation. RESULTS: This manuscript reports a narrative reappraisal combined with authoritative expert opinion on the physiological role of T throughout the male aging process, with emphasis on the critical interpretation of the hypogonadal conditions associated with sexual dysfunction and male factor infertility. Likewise, particular attention was paid to relevant everyday clinical topics including cardiovascular health, metabolism and bone safety, and PCa survivorship. Clinically effective recommendations were given for 14 categories concerning hypogonadism diagnosis and 15 categories on testosterone therapy. STRENGTHS AND LIMITATIONS: The combined main strength and limitation is the narrative profile of this literature review, which was intentionally devoted to addressing the critical clinical aspects of male hypogonadism, while neither provides a systematic review nor a meta-analysis of the most updated published data. CONCLUSIONS: This manuscript discusses relevant clinical aspects and management recommendations of the 5th ICSM committee on male hypogonadism.