The AUA Panel on the Evaluation and Management of Testosterone Deficiency suggests that to be eligible for testosterone therapy patients must have low testosterone levels combined with symptoms or signs associated with low testosterone 1. Historically, testosterone deficiency has been treated with various formulations of exogenous testosterone.
Figures 1 , 2 Additionally, many formulations of exogenous testosterone require invasive administration via injections and can result in large swings in serum testosterone levels with associated recurrence of symptoms.
Alternative formulations of exogenous testosterone, such as gels or creams, have the risk of transference to others. Though testosterone therapy improves bone mineral density, lean body mass, erectile function, and anemia, there is inconclusive evidence on the benefits of testosterone therapy on cognitive function, energy levels, blood glucose or lipid levels, and controversy remains around whether testosterone therapy affects the risk of cardiovascular events 6 - Testosterone therapy may also lead to polycythemia, and while some studies have not linked testosterone therapy to increases in venothrombolic events VTE , other studies suggest that there is an increased risk of VTE in the first six months of treatment, and warnings regarding cardiovascular and embolic events remain in the drug packaging information 14 , Given the side effects and controversies of exogenous testosterone therapy, much work has been done to identify effective alternatives to treat symptomatic testosterone deficiency.
This review aims to discuss in detail the options for management of testosterone deficiency in men, outside of exogenous testosterone. Studies have shown that both low testosterone and obesity increase the risk of major adverse cardiac events 16 , Recent preliminary data have shown that low endogenous testosterone levels are associated with lower high-density lipoprotein HDL cholesterol and higher low-density lipoprotein cholesterol, triglyceride, and total cholesterol levels As such, the AUA recommends counseling men with testosterone deficiency to increase physical activity and maintain their weight within the recommended range to reduce the signs and symptoms of testosterone deficiency and increase serum testosterone levels 1.
Armamento-Villareal and colleagues reported that dietary interventions, with and without exercise, resulted in significant increases in total testosterone levels Similarly, Moran et al. Men lost a mean of Additionally, men with moderate to severe baseline erectile dysfunction had significant increases in the International Index of Erectile Function IIEF erectile function domain following weight loss More recently, Rigon and colleagues evaluated 29 men with a mean baseline weight of BMI improved to a mean of Aside from maintaining a healthy weight, sleep quality has been associated with symptoms of testosterone deficiency.
