Researchers have called for revision of the existing clinical guidelines regarding the testing of testosterone deficiency in men to ensure that quality care is delivered. This was done following a new study, which was presented at the European Congress of Endocrinology in Dublin.
According to the study, the existing guidelines are not effective because some men are misdiagnosed with the deficiency while others are missed. A lot of controversy shrouds the diagnosis and management of the symptoms of testosterone deficiency, also referred to as hypogonadism, in middle aged men.
Some of the side effects that are likely to come with this condition are:
- Decreased libido
- Higher metabolic syndrome
With age, men naturally experience lower testosterone levels. However, the point of concern in recent years is the increasing number of men displaying symptoms of suggestive hypogonadism and testosterone levels below the lower limit for young men.
Data belonging to the European Male Aging Study, EMAS, was used by researchers at the University of Leuven in Belgium and the University of Manchester in the UK. The facts were primarily used to establish the comparative significance of total and free testosterone measurements in diagnosing the deficiency.
According to researchers, testosterone can be found in two states in male bodies. These two states are protein bound, which accounts for about 98 per cent of the total testosterone, and non-protein bound or free which accounts for about 2 per cent of the total testosterone. The later is the active fraction.
Recent studies show that out of the two states, levels of free testosterone are more reliable in suggesting the total testosterone levels in men. However, the current guidelines support measuring the total testosterone levels for diagnosing the deficiency.
Testosterone action is only determined by free testosterone that is capable of entering cells. When men advance in age, the protein that binds testosterone increases and the total level decreases. This means that when compared with total testosterone, free testosterone reduces more with age.
According to Dr Leen Antonio from the University of Leuven, the study shows that symptoms of hypogonadism are more among elderly and middle aged men who have normal levels of total testosterone but lower levels of free testosterone. Going by the current guidelines, such men will not be diagnosed with the deficiency.
He added that the current guidelines will also lead to men who have low levels of total testosterone but normal free testosterone levels being wrongly diagnosed with the deficiency. As a result, they get treatment that they do not require.
The researchers are now calling for a set of new guidelines that will recommend measuring free testosterone instead of total testosterone for diagnosing testosterone deficiency and evaluating men with testosterone deficiency symptoms.