Introduction
Hypogonadism (HG), or testosterone (T) deficiency, is referred to as the syndrome of symptoms resulting from insufficient serum levels of testosterone, which results in inadequate action in sensitive tissues. Its role has been investigated for thousands of years, and the Romans are reported to have observed its impact on energy, erectile function, and urination.1 The causes are several, but they can be categorized into two primary groups: primary hypogonadism or testicular failure, acquired or congenital and secondary hypogonadism, which implies the origin of the syndrome is found in the hypothalamus or the pituitary gland including complex mechanisms.2 Klinefelter syndrome (KS) represents one of the commonest, congenital causes of primary hypogonadism.3 Conversely, the aging of the testicles seems to be a natural phenomenon as men will experience roughly a 12% per year reduction of their circulating testosterone levels starting at the beginning of fifth decade, which eventually results in the development of the late-onset hypogonadism (LOH).4 The timing of the manifestations varies according to the cause as congenital causes will manifest primarily as incomplete or delayed sexual development at childhood whereas late-onset or acquired hypogonadism will present more frequently as loss of libido, fatigue, mood disorders, and erectile dysfunction in older age.5,6
Hypogonadism presents as a clinical syndrome. This includes a combination of a variety of nonspecific signs and symptoms is present in addition to the hormonal imbalance. Incomplete sexual development, erectile and sexual dysfunction, decreased energy, mood disorders, muscle weakness, fatigue, sleeping difficulties, infertility, and chronic pain are the main manifestations of testosterone deficiency, which alone or in combination will affect significantly the quality of life of affected men.710 In aged males, the condition warrants high suspicion as symptoms are not specific. A combination of low energy, sleep disturbances, loss of libido, underperformed sexual activity, and emotional stress should trigger screening for hypogonadism in men above (but not limited to) the age of 40.7,11
Testosterone replacement therapy (TRT) or supplementation therapy (TST) has positive effects on body weight and metabolism, bone and liver health, cardiovascular status, sexual, and micturition health, and sarcopenia.12 It has been offered in multiple pharmacological forms (oral administration, injections gel, transdermal patches, etc) for the restoration of normal testosterone levels in cases of both primary and secondary hypogonadism when clinically appropriate.1 When hypogonadism is complicated by infertility, special hormonal manipulations are needed as low testosterone interferes with the spermatogenesis, but pure TRT may negatively affect the reproductive axis.13,14 Testosterone replacement differs to treatment with human chorionic gonadotropin (HCG), which is used to treat secondary hypogonadism and improve spermatogenesis by stimulating the Leydig cells without the side effects on fertility seen in TRT.15 Apart from the beneficial effect on the hormonal status, TRT has been found efficient to improve the quality of life in hypogonadic men as part of a multidisciplinary team approach as illustrated in subjective tools and metrics.1618 Various questionnaires and scoring systems have been proposed as assessors for the standardized evaluation of the effect on quality of life (QoL) along with the measurement of clinical parameters and should comprise the routine approach as QoL endpoints might elude.19,20 Specific questionnaires such as the widespread used aging males symptom rating scale (AMS) have been well-established as they assess several views of quality of life including sexual, somatic, and psychological aspects.18 However, a more delicate and thorough tool might be needed in men where the chief complaint comes from the mental sphere, sexuality, or chronic pain.21,22 Moreover, lower urinary tract symptoms are quite common in aging men with hypogonadism, affecting quality of life warranting follow-up.23 However, a standard regime for monitoring the QoL in men on TRT is unknown and the optimal tools are yet to be established. So far, no specific tools affecting QoL in men on TRT has been suggested or included in international guidelines.24 In this paper, we review the indications and the rationality of the available tools monitoring QoL in adult men with LOH on TRT, and we provide the evidence for their usage.
A nonsystematic search in PubMed/Medline, Google Scholar, Web of Science, and Embase was performed using the terms testosterone replacement therapy and quality of life, chronic pain, lower urinary tract symptoms, general health, well-being, sexual health, questionnaire. Outstanding studies escaped from engine search were selected through the full texts of the reviewed papers. Exclusion criteria were non-English, animal, and retracted studies. We select the evidence related to the specialism of tools in the below domains: general health assessment, lower urinary tract symptoms, sexual health assessment, mental health, in men treated with TRT for LOH.
The aging males symptoms (AMS) scale was developed in 1999 as a tool to aid assessment of andropause including evaluation of symptoms, severity, and response to TRT. It consists of 17 questions of somatic, psychological, and sexual symptoms and the score varies from 17 (minimal significance) to 85 (severe symptoms consistent to TD).25 It has been one of the most extensively used assessors of quality of life in men treated with hypogonadism and reduction of the score indicates treatment success in terms of quality of life improvements.26 Domains of the questionnaires can also be used separately for the assessment of the chief complaint such as sleep disturbance/apnoea which is not an uncommon manifestation of HG.7 Furthermore, it seems that the tool follows reliably the severity of the symptoms and the complexity of HG. Jeong et al reported that men with metabolic syndrome showed less improvement in the AMS scale reflecting directly the effect of the complications on quality of life.27 Similarly, the androgen deficiency in the aging male (ADAM) questionnaire is another used tool initially designed for the screening of low testosterone. This questionnaire is shorter and consists of 10 questions with a binary response (yes/no) assessing sexual life, energy levels, mood, and activities performance. It has been used, but less frequently compared to AMS, for the assessment of the response to TRT and reduction in the score indicates improvement in quality of life.28 Similarly to AMS, the questionnaire can be used for the assessment of single complaints such as the psychological aspects and for the monitoring of men with chronic pain.22,29 Short-form health survey (SF) questionnaires have been developed for monitoring the QoL in patients with chronic conditions and other stressful circumstances.30 They assess aspects of general health, physical functioning, role physical, bodily pain, vitality, social functioning, mental health, and emotional status.31 The original questionnaire consisted of 36 questions (SF36) has been used in young male cancer survivors treated for hypogonadism. This study did not reveal any changes in QoL but the outcome might be the result of selection bias.32 A shorter version of eight questions, the SF-8 has also been reported to assess the response to individual symptoms and the treatment effect of testosterone.19
Evaluation of the QoL related to lower urinary tract symptoms (LUTS) in men treated for HG is clinically relevant as there is a theoretical effect of testosterone on prostate growth. A 12% significant increase on prostate volume in hypogonadic men (with no bothering urinary tract symptoms) treated with TRT has been reported.33 Moreover, LUTS are reported quite common in aging men treated for hypogonadism, likely the result of concurrent BPH.23 Although the association of hypogonadism and LUTS is weak, men with obstructive symptoms due for surgery and international prostate symptoms score IPSS >19 have been reported with higher testosterone concentrations compared with men with lower score.34 In contrast, a meta-analysis has reported that alterations in IPSS for an average follow-up of three years were similar between men who received TRT versus those not treated. As a result and compared to the previous dogma, TRT should not be regarded an absolute, but rather a relative, contraindication in men with severe BPH.23,35 However, a critical view in studies showing no deterioration in IPSS with TRT may reveal that relevant information regarding the anatomical risk factors (eg, prostate volume) were unreported, whereas in others, men with high IPSS were excluded.35 Therefore, it is advisable that assessment of urinary tract symptoms be included in the follow-up of hypogonadic men treated with testosterone replacement. In that regard, the IPSS represents a well-reported, reliable tool in monitoring and can facilitate as an indirect measure of quality of life.35 Using IPSS, changes in both voiding and storage type of symptoms can be detected promptly in men on moderate to severe scale, in the very early follow-up of treatment at three months and even if TRT is used as monotherapy without addition of BPH drugs.3638 Furthermore and of interest, alterations in urinary symptoms have been reported not to be linked with similar effects of testosterone on general body health such as weight loss and sexual health; thus, IPSS looks sensible to remain during follow-up and not to be substituted by other markers of clinical response.39
Hypogonadism has been a well-documented cause of loss of libido and reduction of sexual activity affecting the quality of life significantly and independently.40,41 TRT compared with placebo has been shown to achieve a significant improvement in sexual health in men with no comorbidities treated for over 30 weeks.42 For the assessment of the response and monitoring of QoL several questionnaires have been proposed. The International Index of Erectile Function (IIEF) is a validated assessment tool for the evaluation of the severity of sexual illness in the concept of hypogonadic men under treatment. It is the more widespread used tool for the assessment of sexual health outcomes.42 It is a self-reported questionnaire of 15 questions, which in its original form assess erectile function, orgasm, desire, intercourse satisfaction, and overall satisfaction. The lower the score, the higher the severity of the symptoms.43 A shorter version (IIEF-5) includes a series of five questions which has been used for the assessment of sexual health in men treated with TRT.20 Replacement therapy has been found to improve all domains of IEFF over a timespan of several weeks following improvements in quality of life.44 Derogatis interview for sexual functioning (DISF-SRII) - scored to 100, where 100 indicates better sexual function is a self-reporting tool which can also be used as an alternative for men in TRT.45 The psychosexual daily questionnaire (PDQ) is a six-question tool providing a useful aspect of the psychosexuality of men with hypogonadism.46 The limitation of the tool is the need of daily completion for a standard period of time, which may vary but should reflect the past period. However, the domains of the questionnaire (desire, pleasure, mood etc) can be used for the assessment of the response to TRT with adequate reproducibility.45 The brief male Sexual function inventory (BMSFI) is a similar questionnaire of 11 questions which include erectile function, ejaculation, personal view of the sexual problem, and overall satisfaction. It has been reported useful for the monitoring of QoL in terms of sexual health in men undergoing TRT.47 Other validated tools such as the mens sexual health questionnaire score could be potentially used, but they are infrequently reported in men on TRT. One study has assessed the usage of the tool in men with testosterone deficiency and profound ejaculatory dysfunction.48
Mental health disorders such as depression or mood fluctuations are one of the principal manifestations of hypogonadism.49 Older and andropause men may see their QoL decline as part of the syndrome.50 Younger men with congenital HG may experience more severe mental disorders (eg, alienation, shame) due to disrupted puberty, infertility issues, or delay to the final diagnosis.51 Much of this dysfunction in hypogonadism can be reversed or improved when appropriate with TRT.52 The domains from the short-form health survey (SF) questionnaires can be used for monitoring mental health in men under treatment.9 The symptom checklist 90 revised (SCL-90-R) is a sum of 90 questions which is used for the assessment of psychological well-being in patients with mental diseases or coming from traumatic situations.53 The questionnaire is quite analytic including questions related to feeling of guilt, agoraphobia, anger, etc. It has been used to assess the magnitude of psychological distress in men with Klinefelter syndrome. Fabrazzo et al reported that men with KS at their 40s experience significantly higher presence of obsessions, compulsions phobias and psychoticism compared to healthy controls based on the analysis by SCL-90-R.16 Domains of the AMS questionnaire (No. 4) can also be used for the assessment of mental health in periodical visits,54 whereas QoL associated with mental health has been found to remain significantly impaired in those with a high AMS score.19 When the chief complaint is depression, questionnaires such as the Hamilton depression rating scale (HAM-D) and the Endicott quality of life enjoyment and satisfaction scale (Q-LES-Q) can be used at diagnosis, follow-up and to alert for relapse.21 The first one assesses the short-term (past three days) anxiety and tension, fears, muscular tension and difficulty in concentration.55 Q-LES-Q comes in a long a short form; the latter one consists of 16 questions assessing the level of satisfaction of the past week related to general activities, feeling of strength and sociality, sexual drive, and others similar parameters. It has been reported to carry the highest specificity.56 It also exists in a pediatric form, which might make it attractive in young-onset hypogonadic patients for the assessment of depressive disorders.57 Finally, AMS and SF questionnaires include questions assessing mental health and well-being.32,58
Quality of life and the entity of hypogonadism are strongly related. Regardless of age of presentation and exact cause, hypogonadic men experience significant deterioration in their well-being. Therefore, both the assessment of the QoL at diagnosis and the re-evaluation during treatment should be regarded integral part of the management. Although all aspects of HG may affect QoL by causing disease-related symptoms, in this paper we focused on the four main domains.
The questionnaires are the cornerstone of the assessment of HG and response to TRT in terms of QoL as holding several advantages. They can be conducted quickly, with low-cost, can be easily repeated and can facilitate research. In contrast, it should be noted that they carry the risk of reporting bias, which may occur due to defensiveness, education, feeling of guilt, and may range from the underreporting edge up to the extreme response bias.59 Also, they lack specificity for HG and therefore, should be utilized after the diagnosis of HG through measurement of testosterone has been established.8 In that regard, if symptoms persist during follow-up other pathologies must be evaluated.
The optimal tool for the assessment of QoL is unknown as no comparison has been reported amongst questionnaires. The sum of the fundamental tools per domain is illustrated in Table 1. The AMS scale and the short-form health survey questionnaires look a wise choice for monitoring as they assess general, social, and mental health; AMS also assess sexual health, but SF does not. The AMS scale can provide rapidly the magnitude and the extent of the effects of HG and the course of TRT.60 Further on, specific tools could be selected according to patients main complaint. In men with profound erectile dysfunction, IIEF score should be used for the assessment of sexual health and repeated during treatment.20 If mental health is mostly impaired, the likelihood of a severe underlying mental condition should be considered. Questionnaires such as the HAM-D scale should be used to assess the possibility of depressive disorder within or additional to the spectrum of HG.21 Although the usage of such questionnaires is quite useful to the urologist, a referral to a specialized clinician should be considered prudent if any signs of mental illness. It is of outmost importance that an indisputable linkage of mental illness to HG be avoided and rather, further investigated. Finally, the presence of LUTS in men with HG is not uncommon, especially in older men. As aforesaid, the old dogma that TRT is contraindicated in men with BPH has been revoked. However, possible selection bias in the reported studies warrants a close follow-up in men with BPH until the safety of TRT is confirmed.35 In that regard, the IPSS should be regarded a great tool for the risk stratification of men on TRT. Furthermore, clinical assessment through biochemical markers (eg, serum testosterone, lipid markers, hematocrit, etc) should also be considered as indirect prognostic assessors of QoL as disease-related symptoms from untreatable disease may affect well-being significantly.61 The optimal schedule of re-evaluating QoL endpoints is not defined, but it would be sensible to be re-evaluated every 36 months as the routine assessment for men on TRT.24
Table 1 Tools for Monitoring QoL
Moreover, a special mention should be made regarding the association between TRT and prostate cancer. That diagnosis of prostatic malignancy is frequent in the male population might be a significant reason for QoL changes.62 It has been reported TRT may neither have an impact on decision-making nor undermine early diagnosis of prostate cancer as the effect on prostate specific antigen (PSA) readings is minimal.63 No effect on overall and specific mortality, and eventually in QoL is expected in selected men having received successful surgical treatment for prostate cancer who receive TRT.64 The findings are consistent with the so-called saturation model which supports that in normal and high testosterone levels prostate growth is insensitive; however, other authors advise that the available evidence should be critically reviewed and any decision-making in that concept should not be based on the model alone.65 Specific guidelines for the management of these patients are still under consideration.66 Given the limitations of our study, a suggested algorithm is illustrated in Table 2. Finally, the peculiarities regarding administration methods (gel, injections, patches, etc) needs to be appreciated as they may be related to patient experience, but the actual effect is unclear as recommendations may be guided by the clinicians.67 Cost and convenience may have an impact on choice, but satisfaction has been reported similar among gels, injections, and implantable pellets.67
Table 2 Suggestion for Monitoring QoL in Men on TRT
We appreciate some limitations in our study. We performed a narrative review, not a systematic one, and the selection of the discussed score systems and questionnaires was based on the panels judgment. Our goal was to present the strategy regarding the utilization of these tools and not to perform a comparative, qualitative, or quantitative analysis. Moreover, it must be noted that our research was focused on the clinical concept of LOH and the treatment with testosterone supplementation in the aging male. Our results may, or may not, have reproducibility in infertile men with secondary hypogonadism treated with HCG.15
Monitoring the QoL in men on TRT warrants a deep insight of the clinical spectrum of HG and thus, a cautious selection of surveillance tools. Questionnaires are the cornerstone, but the optimal tool is unknown. A tool assessing several domains of QoL should be selected. However, in order that all aspects of well-being are monitored, a clinician may need to combine the tools and target the chief complaint. Finally, as the clinical spectrum of HG is not specific, questionnaires can be used to unmask coexistent mental illness. In cases of high suspicion, a specialist referral must be considered.
The authors report no conflicts of interest in this work.
1. Rostom M, Ramasamy R, Kohn TP. History of testosterone therapy through the ages. Int J Impot Res. 2022. doi:10.1038/s41443-021-00493-w
2. Grinspon RP. Genetics of congenital central hypogonadism. Best Pract Res Clin Endocrinol Metab. 2021;101599. doi:10.1016/j.beem.2021.101599
3. Lanfranco F, Kamischke A, Zitzmann M, Nieschlag E. Klinefelters syndrome. Lancet. 2004;364:273283. doi:10.1016/S0140-6736(04)16678-6
4. Jaschke N, Wang A, Hofbauer LC, Rauner M, Rachner TD. Late-onset hypogonadism: clinical evidence, biological aspects and evolutionary considerations. Ageing Res Rev. 2021;67:101301. doi:10.1016/j.arr.2021.101301
5. Raynor MC, Carson CC, Pearson MD, Nix JW. Androgen deficiency in the aging male: a guide to diagnosis and testosterone replacement therapy. Can J Urol. 2007;14 Suppl 1:6368.
6. Lizarazo AH, McLoughlin M, Vogiatzi MG. Endocrine aspects of Klinefelter syndrome. Curr Opin Endocrinol Diabetes Obes. 2019;26:6065. doi:10.1097/MED.0000000000000454
7. Shigehara K, Konaka H, Sugimoto K, et al. Sleep disturbance as a clinical sign for severe hypogonadism: efficacy of testosterone replacement therapy on sleep disturbance among hypogonadal men without obstructive sleep apnea. Aging Male Off J Int Soc Study Aging Male. 2018;21:99105. doi:10.1080/13685538.2017.1378320
8. Tharakan T, Miah S, Jayasena C, Minhas S. Investigating the basis of sexual dysfunction during late-onset hypogonadism [version 1; peer review: 2 approved]. F1000Research. 2019;8:8. doi:10.12688/f1000research.17047.1
9. Finas D, Bals-Pratsch M, Sandmann J, et al. Quality of life in elderly men with androgen deficiency. Andrologia. 2006;38:4853. doi:10.1111/j.1439-0272.2006.00684.x
10. Aydogan U, Aydogdu A, Akbulut H, et al. Increased frequency of anxiety, depression, quality of life and sexual life in young hypogonadotropic hypogonadal males and impacts of testosterone replacement therapy on these conditions. Endocr J. 2012;59:10991105. doi:10.1507/endocrj.EJ12-0134
11. Miner M, Canty DJ, Shabsigh R. Testosterone replacement therapy in hypogonadal men: assessing benefits, risks, and best practices. Postgrad Med. 2008;120:130153. doi:10.3810/pgm.2008.09.1914
12. Fink JE, Hackney AC, Matsumoto M, Maekawa T, Horie S. Mobility and biomechanical functions in the aging male: testosterone and the locomotive syndrome. Aging Male. 2021;23:403410. doi:10.1080/13685538.2018.1504914
13. Colpi GM, Francavilla S, Haidl G, et al. European academy of andrology guideline management of oligo-astheno-teratozoospermia. Andrology. 2018;6:513524. doi:10.1111/andr.12502
14. Li HJ. More attention should be paid to the treatment of male infertility with drugs-testosterone: to use it or not? Asian J Androl. 2014;16:270273. doi:10.4103/1008-682X.122343
15. Fink J, Schoenfeld BJ, Hackney AC, Maekawa T, Horie S. Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility. Expert Rev Endocrinol Metab. 2020;16:18. doi:10.1080/17446651.2021.1863783
16. Fabrazzo M, Accardo G, Abbondandolo I, et al. Quality of life in Klinefelter patients on testosterone replacement therapy compared to healthy controls: an observational study on the impact of psychological distress, personality traits, and coping strategies. J Endocrinol Invest. 2021;44:10531063. doi:10.1007/s40618-020-01400-8
17. Arver S, Luong B, Fraschke A, et al. Is testosterone replacement therapy in males with hypogonadism cost-effective? An analysis in Sweden. J Sex Med. 2014;11:262272. doi:10.1111/jsm.12277
18. Nian Y, Ding M, Hu S, et al. Testosterone replacement therapy improves health-related quality of life for patients with late-onset hypogonadism: a meta-analysis of randomized controlled trials. Andrologia. 2017;49:e12630. doi:10.1111/and.12630
19. Sumii K, Miyake H, Enatsu N, Matsushita K, Fujisawa M. Prospective assessment of health-related quality of life in men with late-onset hypogonadism who received testosterone replacement therapy. Andrologia. 2016;48:198202. doi:10.1111/and.12433
20. Almehmadi Y, Yassin AA, Nettleship JE, Saad F. Testosterone replacement therapy improves the health-related quality of life of men diagnosed with late-onset hypogonadism. Arab J Urol. 2016;14:3136. doi:10.1016/j.aju.2015.10.002
21. Seidman SN, Rabkin JG. Testosterone replacement therapy for hypogonadal men with SSRI-refractory depression. J Affect Disord. 1998;48:157161. doi:10.1016/S0165-0327(97)00168-7
22. Kato Y, Shigehara K, Kawaguchi S, et al. Efficacy of testosterone replacement therapy on pain in hypogonadal men with chronic pain syndrome: a subanalysis of a prospective randomised controlled study in Japan (EARTH study). Andrologia. 2020;52:e13768. doi:10.1111/and.13768
23. Lee MH, Shin YS, Kam SC. Correlation between testosterone replacement treatment and lower urinary tract symptoms. Int Neurourol J. 2021;25:1222. doi:10.5213/inj.2040234.117
24. Salonia A, Bettocchi C, Carvalho J, et al. Sexual and Reproductive Health EAU Guidelines. Arnhem, Netherlands: European Association of Urology; 2021:282.
25. Heinemann LAJ, Tamburini M, Melville M, et al. The Aging Males Symptoms (AMS) scale: update and compilation of international versions. Health Qual Life Outcomes. 2003;1:15. doi:10.1186/1477-7525-1-1
26. Guo C, Gu W, Liu M, et al. Efficacy and safety of testosterone replacement therapy in men with hypogonadism: a meta-analysis study of placebo-controlled trials. Exp Ther Med. 2016;11:853863. doi:10.3892/etm.2015.2957
27. Jeong SM, Ham BK, Park MG, et al. Effect of testosterone replacement treatment in testosterone deficiency syndrome patients with metabolic syndrome. Korean J Urol. 2011;52:566571. doi:10.4111/kju.2011.52.8.566
28. Morrison BF, Reid M, Madden W, Burnett AL. Testosterone replacement therapy does not promote priapism in hypogonadal men with sickle cell disease: 12-month safety report. Andrology. 2013;1:576582. doi:10.1111/j.2047-2927.2013.00084.x
29. Yamaguchi K, Ishikawa T, Chiba K, Fujisawa M. Assessment of possible effects for testosterone replacement therapy in men with symptomatic late-onset hypogonadism. Andrologia. 2011;43:5256. doi:10.1111/j.1439-0272.2009.01015.x
30. Sansom GT, Kirsch K, Horney JA. Using the 12-item short form health survey (SF-12) to assess self rated health of an engaged population impacted by hurricane Harvey, Houston, TX. BMC Public Health. 2020;20:257. doi:10.1186/s12889-020-8349-x
31. Tang W, Niu H, Yang Y, et al. Efficacy and safety of transurethral resection of bladder tumor for superficial bladder cancer. Am J Transl Res. 2021;13:1286012867.
32. Walsh JS, Marshall H, Smith IL, et al. Testosterone replacement in young male cancer survivors: a 6-month double-blind randomised placebo-controlled trial. PLoS Med. 2019;16:e1002960. doi:10.1371/journal.pmed.1002960
33. Holmng S, Mrin P, Lindstedt G, Hedelin H. Effect of long-term oral testosterone undecanoate treatment on prostate volume and serum prostate-specific antigen concentration in eugonadal middle-aged men. Prostate. 1993;23:99106. doi:10.1002/pros.2990230203
34. Favilla V, Cimino S, Castelli T, et al. Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia. BJU Int. 2010;106:17001703. doi:10.1111/j.1464-410X.2010.09459.x
35. Kohn TP, Mata DA, Ramasamy R, Lipshultz LI, Catto J. Effects of testosterone replacement therapy on lower urinary tract symptoms: a systematic review and meta-analysis. Eur Urol. 2016;69:10831090. doi:10.1016/j.eururo.2016.01.043
36. Okada K, Miyake H, Ishida T, et al. Improved lower urinary tract symptoms associated with testosterone replacement therapy in Japanese men with late-onset hypogonadism. Am J Mens Health. 2018;12:14031408. doi:10.1177/1557988316652843
37. Ko YH, Moon DG, Moon KH. Testosterone replacement alone for testosterone deficiency syndrome improves moderate lower urinary tract symptoms: one year follow-up. World J Mens Health. 2013;31:4752. doi:10.5534/wjmh.2013.31.1.47
38. Amano T, Imao T, Takemae K, Iwamoto T, Nakanome M. Testosterone replacement therapy by testosterone ointment relieves lower urinary tract symptoms in late onset hypogonadism patients. Aging Male Off J Int Soc Study Aging Male. 2010;13:242246. doi:10.3109/13685538.2010.487552
39. Yassin D-J, El Douaihy Y, Yassin AA, et al. Lower urinary tract symptoms improve with testosterone replacement therapy in men with late-onset hypogonadism: 5-year prospective, observational and longitudinal registry study. World J Urol. 2014;32:10491054. doi:10.1007/s00345-013-1187-z
40. Corona G, Petrone L, Paggi F, et al. Sexual dysfunction in subjects with Klinefelter s syndrome. Int J Androl. 2010;33:574580. doi:10.1111/j.1365-2605.2009.00986.x
41. Brooke JC, Walter DJ, Kapoor D, et al. Testosterone deficiency and severity of erectile dysfunction are independently associated with reduced quality of life in men with type 2 diabetes. Andrology. 2014;2:205211. doi:10.1111/j.2047-2927.2013.00177.x
42. Taniguchi H, Shimada S, Kinoshita H. Testosterone therapy for late-onset hypogonadism improves erectile function: a systematic review and meta-analysis. Urol Int. 2021;114. doi:10.1159/000520135
43. Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822830. doi:10.1016/S0090-4295(97)00238-0
44. Hackett G, Cole N, Bhartia M, et al. Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. placebo in a population of men with type 2 diabetes. J Sex Med. 2013;10:16121627. doi:10.1111/jsm.12146
45. Wang C, Stephens-Shields AJ, DeRogatis LR, et al. Validity and clinically meaningful changes in the psychosexual daily questionnaire and derogatis interview for sexual function assessment: results from the testosterone trials. J Sex Med. 2018;15:9971009. doi:10.1016/j.jsxm.2018.05.008
46. Lee KK, Berman N, Alexander GM, et al. A simple self-report diary for assessing psychosexual function in hypogonadal men. J Androl. 2003;24:688698. doi:10.1002/j.1939-4640.2003.tb02728.x
47. Khera M, Bhattacharya RK, Blick G, et al. Improved sexual function with testosterone replacement therapy in hypogonadal men: real-world data from the Testim Registry in the United States (TRiUS). J Sex Med. 2011;8:32043213. doi:10.1111/j.1743-6109.2011.02436.x
48. Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: a randomized controlled trial. J Clin Endocrinol Metab. 2015;100:29562962. doi:10.1210/jc.2014-4434
49. Sharma A, UlHaq Z, Sindi E, et al. Clinical characteristics and comorbidities associated with testosterone prescribing in men. Clin Endocrinol. 2022;96:227235. doi:10.1111/cen.14643
50. Huhtaniemi IT. Andropause - lessons from the European Male Ageing Study. Ann Endocrinol. 2014;75:128131. doi:10.1016/j.ando.2014.03.005
51. Dwyer AA, Smith N, Quinton R. Psychological aspects of congenital hypogonadotropic hypogonadism. Front Endocrinol. 2019;10:353.
52. As P, Nn T, Ka O, Jc H. Benefits and consequences of testosterone replacement therapy: a review. Eur Endocrinol. 2013;9:5964. doi:10.17925/EE.2013.09.01.59
53. Pedrini L, Ferrari C, Lanfredi M, et al. The association of childhood trauma, lifetime stressful events and general psychopathological symptoms in euthymic bipolar patients and healthy subjects. J Affect Disord. 2021;289:6673. doi:10.1016/j.jad.2021.04.014
54. Shigehara K, Konaka H, Koh E, et al. Effects of testosterone replacement therapy on nocturia and quality of life in men with hypogonadism: a subanalysis of a previous prospective randomized controlled study in Japan. Aging Male off J Int Soc Study Aging Male. 2015;18:169174. doi:10.3109/13685538.2015.1038990
55. Bech P. Rating scales in depression: limitations and pitfalls. Dialogues Clin Neurosci. 2006;8:207215. doi:10.31887/DCNS.2006.8.2/pbech
56. Stevanovic D. Quality of life enjoyment and satisfaction questionnaire - short form for quality of life assessments in clinical practice: a psychometric study. J Psychiatr Ment Health Nurs. 2011;18:744750. doi:10.1111/j.1365-2850.2011.01735.x
57. Endicott J, Nee J, Yang R, Wohlberg C. Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q): reliability and validity. J Am Acad Child Adolesc Psychiatry. 2006;45:401407. doi:10.1097/01.chi.0000198590.38325.81
58. Rosen RC, Wu F, Behre HM, et al. Quality of life and sexual function benefits of long-term testosterone treatment: longitudinal results from the Registry of Hypogonadism in Men (RHYME). J Sex Med. 2017;14:11041115. doi:10.1016/j.jsxm.2017.07.004
59. Lanyon RI, Wershba RE. The effect of underreporting response bias on the assessment of psychopathology. Psychol Assess. 2013;25:331338. doi:10.1037/a0030914
60. Moncada I. Testosterone and mens quality of life. Aging Male Off J Int Soc Study Aging Male. 2006;9:189193. doi:10.1080/13685530601003180
61. Morley JE. Testosterone replacement in older men and women. J Gender. 2001;4:4953.
62. Dunlop E, Ferguson A, Mueller T, et al. What matters to patients and clinicians when discussing the impact of cancer medicines on health related quality of life? Consensus based mixed methods approach in prostate cancer. Support Care Cancer. 2021;30:31413150. doi:10.1007/s00520-021-06724-6
63. Coward RM, Simhan J, Carson CC. Prostate-specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy. BJU Int. 2009;103:11791183. doi:10.1111/j.1464-410X.2008.08240.x
64. Miah S, Tharakan T, Gallagher KA, et al. The effects of testosterone replacement therapy on the prostate: a clinical perspective [version 1; referees: 2 approved]. F1000Research. 2019;8:217. doi:10.12688/f1000research.16497.1
65. Kim JW. Questioning the evidence behind the saturation model for testosterone replacement therapy in prostate cancer. Investig Clin Urol. 2020;61:242249. doi:10.4111/icu.2020.61.3.242
66. Bell MA, Campbell JD, Joice G, Sopko NA, Burnett AL. Shifting the paradigm of testosterone replacement therapy in prostate cancer. World J Mens Health. 2018;36:103109. doi:10.5534/wjmh.170007
67. Kovac JR, Rajanahally S, Smith RP, et al. Patient satisfaction with testosterone replacement therapies: the reasons behind the choices. J Sex Med. 2014;11:553562. doi:10.1111/jsm.12369
Here is the original post:
Testosterone Replacement Therapy in the Aged Male: Monitoring Patients | IJGM - Dove Medical Press
