The Burden of Testosterone Deficiency Syndrome in Adult Men: Economic and Quality-of-Life Impact (original) (raw)

2007, The Journal of Sexual Medicine

Testosterone deficiency syndrome (TDS) causes a wide range of symptoms that can lead to significant morbidity. Preliminary evidence has also linked TDS with premature mortality and with a number of co-morbid diseases including diabetes and metabolic syndrome. Such associations can lead to substantial economic and quality of life implications, the magnitude of which remains largely unknown. Despite the availability of effective treatment, TDS is a largely under-diagnosed and under-treated condition. Understanding the burden of TDS is impeded by a number of issues. First, there is a lack of clear universally accepted diagnostic criteria. Testosterone threshold levels below which a diagnosis of TDS should be made and treatment started differs between guidelines, countries and laboratories. Second, the link between TDS and some of the consequences that carry economic and quality of life implications are still unclear. The symptoms that potentially add to the economic burden include depression, sexual dysfunction, mild cognitive impairment, osteoporosis, cardiovascular disease and mortality. However, although good evidence exists demonstrating an association between TDS and sexual dysfunction and cognitive impairment, evidence is less strong for depression, the incidence of fractures and mortality and highly controversial for cardiovascular disease. The consequences that are likely to impact on patients' quality of life include sexual function, energy levels, body composition, mood and cognitive function. Understanding the burden is only the first step decision-makers need to take to decide whether to allocate scarce resources to treat the condition. To make informed decisions on when and who to treat information is also needed on the cost-effectiveness of available treatments. Such data would highlight the benefits of treatment of TDS to physicians, patients and to society as a whole.