Evaluation and Management of Testosterone Deficiency: AUA Guideline.

PURPOSE: There has been a marked increase in testosterone prescriptions in the past decade resulting in a growing need to give practicing clinicians proper guidance on the evaluation and management of the testosterone deficient patient. MATERIALS AND METHODS: A systematic review utilized research from the Mayo Clinic Evidence Based Practice Center and additional supplementation by the authors. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions (table 1 in supplementary unabridged guideline, http://jurology.com/). RESULTS: This guideline was developed by a multi-disciplinary panel to inform clinicians on the proper assessment of patients with testosterone deficiency and the safe and effective management of men on testosterone therapy. Additional statements were developed to guide the clinician on the appropriate care of patients who are at risk for or have cardiovascular disease or prostate cancer as well as patients who are interested in preserving fertility. CONCLUSIONS: The care of testosterone deficient patients should focus on accurate assessment of total testosterone levels, symptoms, and signs as well as proper on-treatment monitoring to ensure therapeutic testosterone levels are reached and symptoms are ameliorated. Future longitudinal observational studies and clinical trials of significant duration in this space will improve diagnostic techniques and treatment of men with testosterone deficiency as well as provide more data on the adverse events that may be associated with testosterone therapy.

Oral postmenopausal hormone therapy, C-reactive protein, and cardiovascular outcomes.

OBJECTIVES: This study examines C-reactive protein (CRP) levels predicting cardiovascular events (CVEs) among hormone therapy (HT) users and nonusers. METHODS: CRP levels are higher in women who use oral HT than those in nonusers; however, whether the same CRP cut-points determine increased cardiovascular risk remains unanswered. CRP was measured at baseline in 10,953 HT users and 15,838 nonusers in the Women's Health Study. In HT nonusers and users, Cox proportional hazard models adjusted for age, cardiovascular risk factors, body mass index, and menopause status were constructed using American Heart Association/Centers for Disease Control and Prevention recommended CRP cut-points for low, average, and high cardiovascular risk as well as HT nonuser- and user-derived quantiles of CRP to predict incident CVEs. RESULTS: CVE risk increased with logarithm CRP for both HT users and nonusers. After adjusting for cardiovascular risk factors including lipids, the multivariable relative risk (RR) per log unit of CRP was 1.27 (95% CI, 1.13-1.44) for HT nonusers and 1.22 (95% CI, 1.07-1.40) for HT users. To compare the risk associated with American Heart Association/Centers for Disease Control and Prevention CRP categories across HT use groups, we fit a model in which nonusers with a CRP level lower than 1 mg/L were the reference group. After adjusting for other risk factors including lipids, HT users with a CRP level of 3 mg/L or higher had an RR of 1.93 (1.38-2.69), whereas nonusers had an RR of 1.92 (1.35-2.72). CONCLUSIONS: CRP predicts CVE in a linear relationship among both HT users and nonusers. CRP levels of 3 mg/L or higher were associated with increased cardiovascular risk in both nonusers and HT users.