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 Aug;12(8):1660-86. doi: 10.1111/jsm.12952.


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.

Keywords: Assessment of Hypogonadism; Etiology of Hypogonadism; Hypogonadism; Testosterone Deficiency; Treatment of Hypogonadism.

Publication types

  • Review

MeSH terms

  • Adult
  • Age of Onset
  • Cardiovascular Diseases / prevention & control*
  • Clinical Protocols
  • Evidence-Based Medicine
  • Hormone Replacement Therapy*
  • Humans
  • Hypogonadism / diagnosis*
  • Hypogonadism / drug therapy
  • Hypogonadism / psychology
  • Male
  • Monitoring, Physiologic
  • Practice Guidelines as Topic
  • Prostatic Neoplasms / prevention & control*
  • Risk Factors
  • Societies, Medical
  • Testosterone / deficiency
  • Testosterone / therapeutic use*


  • Testosterone