Review ArticleHormonal regulation of male reproduction and hypogonadismThe World Journal ofpISSN:2287-4208/elSSN:2287-4690World J Mens Health Published online Feb 22,2023MEN's HEALTHhttps://doi.org/10.5534/wjmh.221027The British Society for Sexual Medicine Guidelineson Male Adult Testosterone Deficiency,withStatements for PracticeGeoffrey Hackett,Michael Kirby ,Rowland W.Reess,T.Hugh Jones7,Asif MuneerMark Livingston Nick Ossei-Gerning12,Janine David Jeff Foster Philip A.KalraSudarshan Ramachandran16Department of Urology,Spire Hospital,Little Aston,Birmingham,Department of Urology,Aston University,Birmingham,Trends inUrology and Men's Health,Letchworth,Faculty of Health Human Sciences,University of Hertfordshire The Prostate Centre,London,Department of Urology,University Hospital Southampton and UCLH,London,Department of Endocrinology Barnsley Hospital,BarnsleyDepartment of Biochemistry,Royal Hallamshire Hospital,University of Sheffield Medical School,Sheffield,Division of Surgery andInterventional Science,NIHR Biomedical Research Centre UCLH,London,Department of Biochemistry,Black Country Pathology Services,Walsall Manor Hospital,Walsall,UK,Cardiff and Vale NHS Trust,Cardiff,"University of South Wales TDS,Bridgend,UK,Departmentof Cardiology,University of Cape Coast,Cape Coast,Ghana,Portway Surgery,Porthcawl,Leamington Spa,UK,Department ofNephrology,NCA,Salford Royal Hospital,Salford,Department of Clinical Biochemistry,University Hospitals Birmingham NHSFoundation Trust,Sutton Coldfield,West Midlands,UKTestosterone deficiency (TD)is an increasingly common problem with significant health implications,but its diagnosis andmanagement can be challenging.A multi-disciplinary panel from BSSM reviewed the available literature on TD and provideevidence-based statements for clinical practice.Evidence was derived from Medline,EMBASE and Cochrane searches onhypogonadism,testosterone therapy (T Therapy)and cardiovascular safety from May 2017 to September 2022.This revealed1,714 articles,including 52 clinical trials and 32 placebo-controlled randomised controlled trials.A total of twenty-five state-ments are provided,relating to five key areas:screening,diagnosis,initiating TTherapy,benefits and risks of T Therapy,andfollow-up.Seven statements are supported by level 1 evidence,eight by level 2,five by level 3,and five by level 4.Recentstudies have demonstrated that low levels of testosterone in men are associated with increased risk of incident type 2 diabe-tes mellitus,worse outcomes in chronic kidney disease and COVID 19 infection with increased all-cause mortality,alongwith significant quality of life implications.These guidelines should help practitioners to effectively diagnose and manageprimary and age-related TD.Keywords:Erectile dysfunction;Hypogonadism;Testosterone deficiency;Testosterone therapyThis is an Open Access artide distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:/creativecommonsorg/icenses/by-nc/
