Amr Meliegy

A B S T R A C T
Introduction. In 2014, the International Society for Sexual Medicine (ISSM) convened a panel of experts to develop
an evidence-based process of care for the diagnosis and management of testosterone deficiency (TD) in adult men.
The panel considered the definition, epidemiology, etiology, physiologic effects, diagnosis, assessment and treatment
of TD. It also considered the treatment of TD in special populations and commented on contemporary controversies
about testosterone replacement therapy, cardiovascular risk and prostate cancer.
Aim. The aim was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and
treatment of diagnosis and management of TD for clinicians without expertise in endocrinology, such as physicians
in family medicine and general urology practice.
Method. A comprehensive literature review was performed, followed by a structured, 3-day panel meeting and
6-month panel consultation process using electronic communication. The final guideline was compiled from reports
by individual panel members on areas reflecting their special expertise, and then agreed by all through an iterative
process.
Results. This article contains the report of the ISSM TD Process of Care Committee. It offers a definition of TD
and recommendations for assessment and treatment in different populations. Finally, best practice treatment
recommendations are presented to guide clinicians, both familiar and unfamiliar with TD.
Conclusion. Development of a process of care is an evolutionary process that continually reviews data and incorporates
the best new research. We expect that ongoing research will lead to new insights into the pathophysiology
of TD, as well as new, efficacious and safe treatments. We recommend that this process of care be reevaluated and
updated by the ISSM in 4 years. Dean JD, McMahon CG, Guay AT, Morgentaler A, Althof SE, Becher EF,
Bivalacqua TJ, Burnett AL, Buvat J, El Meliegy A, Hellstrom WJG, Jannini EA, Maggi M, McCullough A,
Torres LO, and Zitzmann M. The International Society for Sexual Medicine’s process of care for the
assessment and management of testosterone deficiency in adult men. J Sex Med 2015;12:1660–1686.