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Assess the response to testosterone treatment at three, six and twelve months after the onset of treatment, and thereafter annually. Monitor testosterone, haematocrit at three, six and twelve months and thereafter annually.

Decrease the testosterone dosage or switch testosterone preparation from intramuscular to topical or venesection, if haematocrit is above 0. If haematocrit remains elevated, stop testosterone and reintroduce at a lower dose once haematocrit has normalised. Assess prostate health by digital rectal examination and prostate-specific antigen (PSA) before the start of testosterone replacement therapy (TRT). Follow-up by PSA tests at three, six and twelve months and thereafter annually. Assess men with cardiovascular diseases for cardiovascular symptoms before testosterone treatment is initiated and continue close clinical assessment during treatment.

This guidelines document was developed with the financial support of the European Association of Urology. No external sources of funding and support have been involved. The EAU is a non-profit organisation, and funding is limited to resolution assistance johnson tsang travel and meeting expenses.

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CONFLICT OF INTEREST 9. Available Publications A quick reference document (Pocket Guidelines) is available, both in print and in a number of versions for mobile devices, presenting the main findings of the Male Hypogonadism Guidelines.

Panel composition The EAU Male Teveten HCT (Eprosartan Mesylate Hydrochlorothiazide Tablets)- Multum Panel consists of a multidisciplinary group of experts, including urologists specialising in andrology, and endocrinologists.

These key open minded are the autocad which panels use to define the strength rating of each recommendation.

Review This document was subject to peer review prior to publication in 2015. Future goals The results of ongoing and new systematic reviews will be included in the 2019 update of the Male Hypogonadism Guidelines.

Ongoing systematic reviews are: What are the risks of major cardiovascular events from testosterone Teveten HCT (Eprosartan Mesylate Hydrochlorothiazide Tablets)- Multum therapy (TRT). Physiology Male sexual development starts between the seventh and twelfth week of gestation.

The androgen receptor Testosterone exerts its action through the AR, located in the cytoplasm and nucleus of target cells. Summary of evidence Testosterone is essential for normal male development. Aetiology Hypogonadism results from testicular failure, or is due to the disruption of one or several levels of the hypothalamic-pituitary-gonadal axis (Figure 2).

Male hypogonadism of testicular origin (primary hypogonadism) Primary testicular failure is the most frequent cause of hypogonadism and results in low testosterone levels, impairment of spermatogenesis and elevated gonadotropins (high LH and FSH).

Klinefelter syndrome affects 0. Testicular germ cell tumours are the most Teveten HCT (Eprosartan Mesylate Hydrochlorothiazide Tablets)- Multum type of cancer in young males after puberty. Risk factors are contralateral germ cell cancer, maldescended testes, gonadal dysgenesis, infertility, testicular atrophy and familial germ cell cancer.

The main reasons for primary hypogonadism are summarised in Table 1. Non aspirin hypogonadism of hypothalamic-hypopituitary origin (secondary hypogonadism) Central defects of the hypothalamus or pituitary cause secondary testicular failure.

Isolated (formerly termed idiopathic) or congenital hypogonadotrophic hypogonadism (IHH, CHH). Male hypogonadism due to defects of androgen target organs These forms are primarily rare defects and will not be further discussed in detail in these guidelines.

History-taking and questionnaires Symptoms of hypogonadism are listed in Table 3 and 4 and congestion definition be addressed during history-taking. Summary of evidence and recommendations for the diagnostic evaluation Teveten HCT (Eprosartan Mesylate Hydrochlorothiazide Tablets)- Multum of black seed black cumin The diagnosis of male hypogonadism is based on signs and symptoms of androgen deficiency, together with consistently low serum testosterone levels.

Recommendations Strength rating Restrict the diagnosis of testosterone deficiency to men with persistent symptoms suggesting hypogonadism (Tables 3 and 4). Strong Measure testosterone in the morning before 11. Strong Repeat total testosterone on at least two occasions with a reliable method. Strong Consider assessing testosterone in men with a disease or treatment in which testosterone deficiency is common and in whom treatment may be indicated. Moderate to severe chronic obstructive lung disease.

Osteoporosis or low-trauma fractures.

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