Practice Guidelines

Testosterone Therapy for Age-Related Low Testosterone: Guidelines from the ACP


Am Fam Physician. 2021 Jan 1;103(1):60-61.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Testosterone therapy leads to small improvements in erectile and global sexual function in patients with age-related low testosterone levels, but offers no other benefits.

• Consider discontinuing therapy for age-related low testosterone levels unless sexual function improves.

• Consider prescribing intramuscular over transdermal testosterone therapy because of identical benefit and much lower cost.

From the AFP Editors

Testosterone levels in men normally diminish with age. For men older than 35 years, testosterone declines by nearly 2% each year. There is no cutoff for low testosterone, although a level of 300 ng per dL (10.41 nmol per L) is used in most trials. One-fifth of patients older than 60 years and one-half of patients older than 80 years have testosterone levels less than 320 ng per dL (11.10 nmol per L), many without symptoms. Treatment of age-related low testosterone is controversial, and no testosterone products are labeled for treatment of age-related effects, including sexual dysfunction. The American College of Physicians (ACP) published guidelines for testosterone therapy in cis gender men with age-related low testosterone based on a systematic review.

Sexual Dysfunction

Testosterone therapy leads to small improvements in global sexual function and erectile function compared with placebo in men with age-related low testosterone levels. The guidelines recommend considering testosterone therapy in cis-gender men with age-related low testosterone levels who want to improve sexual function and prescribing replacement therapy only after discussion with the patient. Because of limited evidence, discontinuing testosterone therapy should be considered in patients who do not report improvement in sexual function within 12 months, after an appropriate trial.

Other Age-Related Symptoms

Testosterone therapy does not improve physical or cognitive function compared with placebo. A questionable improvement in objective physical tests is

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at



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