Open Access

POINT-COUNTERPOINT DEBATE

POINT: Urologists should take an active role in the diagnosis and treatment of hypogonadism in the aging male

Jeremy P. W. Heaton

Departments of Urology, Pharmacology and Toxicology, Queen's University, Kingston, Ontario, Canada
Address correspondence to Dr. Jeremy P.W. Heaton, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7

Canadian Journal of Urology 2002, 9(6), 1677-1680.

Abstract

Andropause is a problem that can be identified in some men as distinct from the changes associated with aging or chronic disease. These men have mild hypogonadism and a clinical picture that is well within the scope of urologists to identify and manage. Andropause is neither life threatening nor trivial and there are clinical guidelines published that will help to refine the understanding and definition of this condition. The character of andropause is distinct from profound hypogonadism in its relation to age, the scope and degree of contributing symptoms and the marginal reduction in testosterone. Testosterone is the established treatment for some men with andropause and the links between testosterone and cancer of the prostate create an overlap in management that places a premium on urological expertise. Obviously men with cancer of the prostate must not be given testosterone and some men may have clinical andropause and undetected cancer of the prostate. However, current understanding points to the fact that there is no additional risk from re-establishing a normal androgen environment (androgen replacement) in terms of initiating a new cancer of the prostate while testosterone will encourage growth of an established cancer. Therefore, the natural good practice of urology, and only urology, intrinsically encompasses the major issues inherent in the medical collision of cancer of the prostate and testosterone replacement. The good practice of urology includes the use of androgen replacement therapy in men who need it and have been assessed for the presence of cancer of the prostate.

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