Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy (SORT) evidence rating system, go to https://www.aafp.org/pubs/afp/issues/2004/0201/p548.html.

1. Obtain one or more semen analyses in the initial evaluation of male patients with infertility.
Evidence rating: SORT A
Source: Section One, reference 2

2. Consider testosterone therapy for male patients who meet criteria for testosterone deficiency (total testosterone level less than 300 ng/dL [10.41 nmol/L] measured on two separate occasions and clinical symptoms or signs) and are suitable candidates for therapy.
Evidence rating: SORT A
Source: Section One, reference 26

3. Male patients with erectile dysfunction and without contraindications to oral phosphodiesterase type 5 inhibitors should be informed about these drugs as a treatment option. This should include a discussion of potential benefits and risks or burdens of use.
Evidence rating: SORT A
Source: Section Two, reference 1

4. For male patients with premature ejaculation, recommend daily selective serotonin reuptake inhibitors, on-demand clomipramine or dapoxetine (where available), and topical penile anesthetics as first-line agents.
Evidence rating: SORT A
Source: Section Three, reference 2

5. For male patients with delayed ejaculation, obtain a morning total testosterone level as part of evaluation.
Evidence rating: SORT C
Source: Section Three, reference 2

6. For patients with chlamydia, prescribe oral doxycycline, 100 mg 2 times/day for 7 days. If drug adherence is a concern, prescribe oral azithromycin, 1 g in a single dose, as an alternative option.
Evidence rating: SORT A
Source: Section Four, reference 10

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