Should “Age-Related” Testosterone Deficiency (TD) Be Treated?

Abdulmaged M. Traish, MBA, PhD, presented “Should ‘Age-Related’ Testosterone Deficiency (TD) Be Treated?” during the 32nd Annual International Prostate Cancer Update (IPCU32) conference on March 8, 2022, in Snowbird, Utah.

How to cite: Traish, Abdulmaged M. “Should ‘Age-Related’ Testosterone Deficiency (TD) Be Treated?” March 8, 2022. Accessed Nov 2024. https://grandroundsinurology.com/should-age-related-testosterone-deficiency-td-be-treated/

Should “Age-Related” Testosterone Deficiency (TD) Be Treated? – Summary

Abdulmaged M. Traish, MBA, PhD, Research Director at The Institute for Sexual Medicine and Emeritus Professor of Urology, both at Boston University School of Medicine in Boston, MA, discusses what he calls a fundamental question—whether age-related testosterone deficiency (TD) should be treated. Dr. Traish questions why the U.S. Food and Drug Administration (FDA) opposes testosterone (T) therapy in older men with TD but not in men with classical hypogonadism and asks whether T therapy in older men with TD produces significant health benefits. He cites resolutions of the International Expert Consensus Conference that state the negative effects of TD on human health and quality of life are well-demonstrated, including signs, symptoms, metabolic syndrome, obesity, and increased mortality. Dr. Traish cites trials in the U.S. and in Australia that indicate that T therapy does, indeed, produce significant health benefits to older men without classical TD. He shares evidence of these significant health benefits (that include no increased cardiovascular events or prostate cancer risks and fewer hospitalizations) and highlights data indicating the positive effect of T therapy on sexual function in men and data indicating that T therapy significantly increased volumetric bone mineral density (vBMD) and strength in older men with low T. Further, he shares data illustrating that T therapy has a role in slowing the development of, and in some cases reversing, type-2 diabetes. Dr. Traish then asserts that the FDA has made an artificial distinction between diagnoses where they indicate T treatment is warranted (classical hypogonadism) and where they indicate it is unwarranted (age-related hypogonadism); he states that this distinction is not clinically or scientifically meaningful and that the FDA is unable to demonstrate that one group differs from the other in terms of benefits or risks of T treatment. Further, he points out that there is no evidence that men with age-related TD respond differently to treatment than do those with classical TD. Dr. Traish highlights the fact that professional societies do not recognize age restrictions for T therapy. Dr. Traish concludes by revisiting his initial question of whether age-related TD merits treatment, to which he states that it does, respectfully disagreeing with the FDA position.

About the 32nd Annual International Prostate Cancer Update (IPCU32):
Presented by Program Chair E. David Crawford, MD,  The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 32 featured lectures, interactive discussions, panel roundtables, debates, and case reports. This conference was led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.