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Evaluation and management of testosterone deficiency Guideline statements Diagnosis of Testosterone Deficiency 睾酮缺失的诊断 1. Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone. (Moderate Recommendation; Evidence Level: Grade B) 1. 建议将总体睾酮水平低于300ng/dL作为支持诊断为低睾酮症的合理的截断点。（标准推荐；证据水平：B级） 2. The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion. (Strong Recommendation; Evidence Level: Grade A) 2. 按上述标准，低睾酮症的诊断，应当以不同的清晨时刻分别测定的两次总睾酮水平的结果为标准。（强烈推荐；证据水平：B级） 3. The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs. (Moderate Recommendation; Evidence Level: Grade B) 3. 临床上睾酮缺失的诊断，仅在患者检测出低睾酮水平且合并症状和（或）体征时确诊。（标准推荐；证据水平：B级） 4. Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even in the absence of symptoms or signs associated with testosterone deficiency. (Moderate Recommendation; Evidence Level: Grade B) 4.在衡量患者总体睾酮水平时，需要考虑既往史中是否包含难以解释的贫血，骨密度的丢失，糖尿病，化疗的暴露，睾丸放疗的暴露，艾滋病，慢性麻醉药品的使用，男性不育症，脑垂体功能障碍及慢性皮质类固醇药物的使用等，存在上述病史，即使无合并有症状或体征，仍需考虑睾酮缺失。（标准推荐；证据水平：B级） 5. The use of validated questionnaires is not currently recommended to either define which patients are candidates for testosterone therapy or to monitor symptom response in patients on testosterone therapy. (Conditional Recommendation; Evidence Level: Grade C) 5. 目前不再推荐使用问卷调查确认的方式来界定哪些候选患者需要睾酮补充疗法，及不再用以监测患者对于睾酮补充疗法的症状反应性。（有条件的推荐；证据水平：C级） Adjunctive Testing 辅助检查 6. In patients with low testosterone, clinicians should measure serum luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) 6. 当患者检测出低睾酮水平，应当进一步检测血清促黄体激素水平。（强烈推荐；证据水平：A级） 7. Serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/normal luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) 7. 当患者检测出低睾酮水平，合并低或（低/正常）的血清促黄体激素水平时，应当进一步检测血清催乳素水平。（强烈推荐；证据水平：A级） 8. Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders. (Strong Recommendation; Evidence Level: Grade A) 8. 患者伴随不明原因的持续高水平的血清催乳素，应当进行充分评估内分泌紊乱。（强烈推荐；证据水平：A级） 9. Serum estradiol should be measured in testosterone deficient patients who present with breast symptoms or gynecomastia prior to the commencement of testosterone therapy. (Expert Opinion) 9. 睾酮缺失患者，伴随乳房症状或在睾酮补充治疗前即出现男性乳腺发育时，应当检测血清雌二醇水平。（专家建议） 10. Men with testosterone deficiency who are interested in fertility should have a reproductive health evaluation performed prior to treatment. (Moderate Recommendation; Evidence Level: Grade B) 10. 睾酮缺失并有生育要求的患者，在治疗前应当进行生殖健康的评估。（标准推荐；证据水平：B级） 11. Prior to offering testosterone therapy, clinicians should measure hemoglobin and hematocrit and inform patients regarding the increased risk of polycythemia. (Strong Recommendation; Evidence Level: Grade A) 11．在提供睾酮补充治疗前，应当检测患者的血清血红蛋白和红细胞压积水平，并告知其可能在治疗后出现红细胞增多症。（强烈推荐；证据水平：A级） 12. PSA should be measured in men over 40 years of age prior to commencement of testosterone therapy to exclude a prostate cancer diagnosis. (Clinical Principle) 12. 在年龄超过40岁的患者开始睾酮补充治疗前，应当常规置检测PSA水平以排除前列腺癌。（临床原则） Counseling Regarding Treatment of Testosterone Deficiency 睾酮缺失的治疗咨询 13. Clinicians should inform testosterone deficient patients that low testosterone is a risk factor for cardiovascular disease. (Strong Recommendation; Evidence Level: Grade B) 13. 应当告知睾酮缺失患者，低睾酮水平是心血管疾病的高危因素之一。（强烈推荐；证据水平：B级） 14. Patients should be informed that testosterone therapy may result in improvements in erectile function, low sex drive, anemia, bone mineral density, lean body mass, and/or depressive symptoms. (Moderate Recommendation; Evidence Level: Grade B) 14. 应当告知患者，睾酮补充治疗可能改善，包括勃起功能，较低性欲，贫血，骨密度，较瘦的体质和（或）抑郁的症状。（标准推荐；证据水平：B级） 15. Patients should be informed that the evidence is inconclusive whether testosterone therapy improves cognitive function, measures of diabetes, energy, fatigue, lipid profiles, and quality of life measures. (Moderate Recommendation; Evidence Level: Grade B) 15. 应当告知患者，睾酮补充治疗能否确凿的改善认知功能，降低糖尿病程度，提升精力，缓解疲乏，降低血脂及改善总体生活水平，这些尚缺乏临床证据。（标准推荐；证据水平：B级） 16. The long-term impact of exogenous testosterone on spermatogenesis should be discussed with patients who are interested in future fertility. (Strong Recommendation; Evidence Level: Grade A) 16. 应当和睾酮缺失并有生育要求的患者充分沟通，长期外源性的睾酮补充对于精子生成的影响。（强烈推荐；证据水平：A级） 17. Clinicians should inform patients of the absence of evidence linking testosterone therapy to the development of prostate cancer. (Strong Recommendation; Evidence Level: Grade B) 17. 应当告知患者，目前并无睾酮补充治疗可能导致前列腺癌的临床证据。（强烈推荐；证据水平：B级） 18. Patients with testosterone deficiency and a history of prostate cancer should be informed that there is inadequate evidence to quantify the risk-benefit ratio of testosterone therapy. (Expert Opinion) 18. 应当告知，既往患有前列腺癌的睾酮缺失患者，具体量化睾酮补充治疗后的风险收益比，尚缺乏充分的临床证据。（专家建议） 19. Patients should be informed that there is no definitive evidence linking testosterone therapy to a higher incidence of venothrombolic events. (Moderate Recommendation; Evidence Level: Grade C) 19. 应当告知患者，目前并无睾酮补充治疗可能导致静脉血栓更高发生率的临床证据。（标准推荐；证据水平：C级） 20. Prior to initiating treatment, clinicians should counsel patients that, at this time, it cannot be stated definitively whether testosterone therapy increases or decreases the risk of cardiovascular events (e.g.myocardialinfarction, stroke, cardiovascular-related death, all-cause mortality). (Moderate Recommendation; Evidence Level: Grade B) 20. 在初始治疗前，应当劝告患者，在此刻睾酮补充治疗不能明确肯定是否会增加或降低心血管事件发生的风险（比如，心梗，中风，心血管相关的猝死，所有可能原因的死亡）。（标准推荐；证据水平：B级） 21. All men with testosterone deficiency should be counseled regarding lifestyle modifications as a treatment strategy. (Conditional Recommendation; Evidence Level: Grade B) 21. 作为一个治疗的策略，所有睾酮缺失的患者都应当被告诫关于生活方式的改变。（有条件的推荐；证据水平：B级） Treatment of Testosterone Deficiency 睾酮缺失的治疗 22. Clinicians should adjust testosterone therapy dosing to achieve a total testosterone level in the middle tertile of the normal reference range. (Conditional Recommendation; Evidence Level: Grade C) 22. 专科医师应当调整睾酮素治疗剂量，以达到患者睾酮水平恢复到正常参考范围的中位数值为宜。（有条件的推荐；证据水平：C级） 23. Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. (Strong Recommendation; Evidence Level: Grade A) 23. 对于目前尝试准备生育的患者，不推荐事先进行外源性的睾酮补充治疗。（强烈推荐；证据水平：A级） 24. Testosterone therapy should not be commenced for a period of three to six months in patients with a history of a cardiovascular events. (Expert Opinion) 24.在患者患有一项心血管相关事件后的3-6个月内，不推荐睾酮补充治疗即开始。（专家建议） 25. Clinicians should not prescribe alkylated oral testosterone. (Moderate Recommendation; Evidence Level: Grade B) 25. 不推荐烷基化来源的口服睾酮药物。（标准推荐；证据水平：B级） 26. Clinicians should discuss the risk of transference with patients using testosterone gels/creams. (Strong Recommendation; Evidence Level: Grade A) 26. 应当探讨患者使用睾酮素凝胶乳膏的潜在转移风险。（强烈推荐；证据水平：A级） 27. Clinicians may use aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators, or a combination thereof in men with testosterone deficiency desiring to maintain fertility. (Conditional Recommendation; Evidence Level: Grade C) 27. 对于睾酮缺失并有强烈生育要求的患者，可以使用芳香酶抑制剂，人促绒毛膜促性腺激素，可选择性的雌激素受体调节剂，或以上的组合用药。（有条件的推荐；证据水平：C级） 28. Commercially manufactured testosterone products should be prescribed rather than compounded testosterone, when possible. (Conditional Recommendation; Evidence Level: Grade C) 28. 有条件时，商业制造的睾酮素产品治疗时优先于混合型的睾酮素制剂。（有条件的推荐；证据水平：C级） Follow-up of Men on Testosterone Therapy 患者睾酮补充治疗后的随访 29. Clinicians should measure an initial follow-up total testosterone level after an appropriate interval to ensure that target testosterone levels have been achieved. (Expert Opinion) 29.专科医师应该估量一段合适的间隔期后，患者首次随诊检测的总体睾酮水平，以确保能达到目标睾酮水平。（专家建议） 30. Testosterone levels should be measured every 6-12 months while on testosterone therapy. (Expert Opinion) 30. 在进行睾酮补充治疗期间，应当每6-12个月检测一次睾酮水平。（专家建议） 31. Clinicians should discuss the cessation of testosterone therapy three to six months after commencement of treatment in patients who experience normalization of total testosterone levels but fail to achieve symptom or sign improvement. (Clinical Principle) 31．睾酮补充治疗开始3-6个月后，患者虽然恢复了正常睾酮水平，但是临床症状或体征却没有得到改善，此刻专科医师应当探讨是否停药。（临床原则） *翻译仅供学习交流，不作为临床实践标准 |
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