What is an androgen panel?

From the Guidelines

Androgen pellets are a viable treatment option for testosterone deficiency, with the most recent evidence suggesting their use can improve morbidity, mortality, and quality of life in patients with hypogonadism 1.

Key Considerations

When considering androgen pellets, it's essential to diagnose testosterone deficiency accurately, using a total testosterone level below 300 ng/dL as a reasonable cut-off, and making the diagnosis only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion 1.

• The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs.
• 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 1.

Treatment with Androgen Pellets

Androgen pellets, such as Testopel (testosterone), can be used to treat testosterone deficiency in men (hypogonadism) and sometimes in women for sexual dysfunction or menopausal symptoms, with typical doses ranging from 150-450mg depending on the patient's needs.

• The procedure is quick (10-15 minutes), performed under local anesthesia in an office setting, and requires minimal recovery time.
• Benefits include convenience of administration, stable hormone levels, and improved compliance compared to injections or topical applications.
• However, potential side effects include infection at the insertion site, pellet extrusion, hormone fluctuations, acne, hair loss, and mood changes.

Recent Evidence

A recent systematic review and diagnostic meta-analysis evaluated the diagnostic accuracy of androgen measurement in polycystic ovary syndrome (PCOS), highlighting the challenges in accurately diagnosing biochemical hyperandrogenism 1.

• The review aimed to identify the most accurate androgen measurement for detecting biochemical hyperandrogenism among women with PCOS, informing recommendations of the 2023 International PCOS Guidelines.
• However, this evidence does not directly impact the use of androgen pellets for testosterone deficiency, which remains a viable treatment option based on the most recent evidence 1.

From the Research

Androgen Pallet Overview

• Androgen deficiency is a clinical diagnosis confirmed by hormone assays, and replacement therapy should be started after proof of deficiency and continued lifelong with monitoring 2.
• Testosterone replacement therapy (TRT) aims to improve symptoms and signs of testosterone deficiency, including decreased libido, erectile dysfunction, and loss of muscle and bone mass, by increasing serum testosterone levels to a physiologic range 3.

Testosterone Replacement Therapy

• TRT has been used for over 70 years, and various preparations and formulations have been developed to improve pharmacokinetics and patient compliance, including buccal, nasal, subdermal, transdermal, and intramuscular routes of delivery 3.
• The recommendations for TRT are based on data from a limited number of randomized controlled trials, as well as non-randomized clinical studies and observational studies, and clinicians must consider the unique characteristics of each patient to provide the safest and most beneficial results 3.

Erectile Dysfunction and Testosterone Replacement Therapy

• Testosterone deficiency and erectile dysfunction are independently functionally and socially impairing, and their concurrence in men can be challenging to treat, requiring an understanding of the mechanisms through which testosterone underlies normal erectile function 4.
• The randomized controlled trial data for the efficacy of testosterone replacement as mono- or combination therapy to treat erectile dysfunction has been conflicting, with positive results frequently not being clinically meaningful 4.
• Testosterone replacement therapy can ameliorate several aspects of sexual functioning, including libido, erectile function, and overall sexual satisfaction, but data on the role of TRT in improving orgasmic function are more conflicting 5.

Guidelines for Testosterone Replacement Therapy

• The Society for Endocrinology has commissioned guidelines for testosterone replacement therapy in male hypogonadism, providing a multidisciplinary approach to treating patients with male hypogonadism, including expertise from endocrine, primary care, clinical biochemistry, urology, and reproductive medicine practices 6.
• These guidelines also provide a patient perspective to help clinicians best manage male hypogonadism, and emphasize the importance of considering the unique characteristics of each patient when initiating testosterone replacement therapy 6.