'Andropause' is too often undertreated

It was recently reported in a review article in the New England Journal of Medicine1 on the monitoring of testosterone replacement therapy that only 5 per cent of men with hypogonadism currently receive treatment.

Late diagnosis and delay in treatment have serious consequences for these patients, including osteoporosis, weight gain, anaemia, erectile dysfunction and depression.

There does indeed appear currently to be a degree of apathy towards this condition despite the impact that a delay in treatment can have.

Hypogonadism, if confirmed biochemically, should be heralded as a serious condition whose cause requires investigation. GPs need to recognise the symptoms when patients present, leading to prompt and early diagnosis through referral and subsequent appropriate therapy.

There have been many recent advances in the different forms of testosterone replacement therapy.

It is my opinion that the optimal outcome for a patient with suspected hypogonadism should be referral to a physician specialising in this condition, usually an endocrinologist, who will have the relevant expertise and skills and experience of the type of testosterone treatment that needs to be customised for the patient.

In addition, the inappropriate use or abuse of therapy will be minimised.

Professor Ashley Grossman

Department of Endocrinology,

St Bartholomew's Hospital

London

1. Rhoden, EL, Morgentaler, A. (2004). Risks of testosterone replacement therapy and recommendations for monitoring. NEJM 350:

482-492