Guidelines

Sexual and Reproductive Health

13. REFERENCES

1.Bob Philips, C.B., Dave Sackett, Doug Badenouch, Sharon Straus, Brian Haynes, Martin Dawes since November 1998. Modified from Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated Jeremy Howick March 2009. Access date February 2014. 1998.

https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009

2.Guyatt, G.H., et al. Going from evidence to recommendations. BMJ, 2008. 336: 1049.

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3.Salonia, A., et al. Paediatric and adult-onset male hypogonadism. Nat Rev Dis Primers, 2019. 5: 38.

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4.Nieschlag, E., et al., Andrology: male reproductive health and dysfunction. 3rd edn. 2010, Heidelberg.

5.Wu, F.C., et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab, 2008. 93: 2737.

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6.Araujo, A.B., et al. Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab, 2011. 96: 3007.

https://pubmed.ncbi.nlm.nih.gov/21816776

7.Haring, R., et al. Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20-79. Eur Heart J, 2010. 31: 1494.

https://pubmed.ncbi.nlm.nih.gov/20164245

8.Wu, F.C., et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med, 2010. 363: 123.

https://pubmed.ncbi.nlm.nih.gov/20554979

9.Zarotsky, V., et al. Systematic literature review of the risk factors, comorbidities, and consequences of hypogonadism in men. Andrology, 2014. 2: 819.

https://pubmed.ncbi.nlm.nih.gov/25269643

10.Ding, E.L., et al. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA, 2006. 295: 1288.

https://pubmed.ncbi.nlm.nih.gov/16537739

11.Corona, G., et al. Testosterone therapy in diabetes and pre-diabetes. Andrology, 2023. 11: 204.

https://pubmed.ncbi.nlm.nih.gov/36542412

12.Bonomi, M., et al. Klinefelter syndrome (KS): genetics, clinical phenotype and hypogonadism. J Endocrinol Invest, 2017. 40: 123.

https://pubmed.ncbi.nlm.nih.gov/27644703

13.Kanakis, G.A., et al. Klinefelter syndrome: more than hypogonadism. Metabolism, 2018. 86: 135.

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14.Aksglaede, L., et al. 47,XXY Klinefelter syndrome: clinical characteristics and age-specific recommendations for medical management. Am J Med Genet C Semin Med Genet, 2013. 163C: 55.

https://pubmed.ncbi.nlm.nih.gov/23345262

15.Pizzocaro, A., et al. Testosterone treatment in male patients with Klinefelter syndrome: a systematic review and meta-analysis. J Endocrinol Invest, 2020. 43: 1675.

https://pubmed.ncbi.nlm.nih.gov/32567016

16.Bojesen, A., et al. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study. J Clin Endocrinol Metab, 2003. 88: 622.

https://pubmed.ncbi.nlm.nih.gov/12574191

17.Santi, D., et al., Primary and Secondary Hypogonadism, in Endocrinology of the Testis and Male Reproduction, M. Simoni & I.T. Huhtaniemi, Editors. 2017, Springer International Publishing: Cham.

18.Giannetta, E., et al. Subclinical male hypogonadism. Best Pract Res Clin Endocrinol Metab, 2012. 26: 539.

https://pubmed.ncbi.nlm.nih.gov/22863395

19.Tajar, A., et al. Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab, 2010. 95: 1810.

https://pubmed.ncbi.nlm.nih.gov/20173018

20.Corona, G., et al. Subclinical male hypogonadism. Minerva Endocrinol (Torino), 2021. 46: 252.

https://pubmed.ncbi.nlm.nih.gov/32969626

21.Isidori, A.M., et al. Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE). J Endocrinol Invest, 2022. 45: 2385.

https://pubmed.ncbi.nlm.nih.gov/36018454

22.Rastrelli, G., et al. Pharmacotherapy of male hypogonadism. Curr Opin Pharmacol, 2023. 68: 102323.

https://pubmed.ncbi.nlm.nih.gov/36525815

23.Giagulli, V.A., et al. Critical evaluation of different available guidelines for late-onset hypogonadism. Andrology, 2020. 8: 1628.

https://pubmed.ncbi.nlm.nih.gov/32593233

24.Morelli, A., et al. Which patients with sexual dysfunction are suitable for testosterone replacement therapy? J Endocrinol Invest, 2007. 30: 880.

https://pubmed.ncbi.nlm.nih.gov/18075293

25.Kelly, D.M., et al. Testosterone and obesity. Obes Rev, 2015. 16: 581.

https://pubmed.ncbi.nlm.nih.gov/25982085

26.Wittert, G., et al. Obesity, type 2 diabetes, and testosterone in ageing men. Rev Endocr Metab Disord, 2022. 23: 1233.

https://pubmed.ncbi.nlm.nih.gov/35834069

27.Muller, M., et al. Endogenous sex hormones and metabolic syndrome in aging men. J Clin Endocrinol Metab, 2005. 90: 2618.

https://pubmed.ncbi.nlm.nih.gov/15687322

28.Dhindsa, S., et al. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab, 2004. 89: 5462.

https://pubmed.ncbi.nlm.nih.gov/15531498

29.Jones, T.H., et al. Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care, 2011. 34: 828.

https://pubmed.ncbi.nlm.nih.gov/21386088

30.Kalinchenko, S.Y., et al. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf), 2010. 73: 602.

https://pubmed.ncbi.nlm.nih.gov/20718771

31.Groti, K., et al. The impact of testosterone replacement therapy on glycemic control, vascular function, and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes. Aging Male, 2018. 21: 158.

https://pubmed.ncbi.nlm.nih.gov/29708829

32.Hackett, G., et al. Testosterone replacement therapy improves metabolic parameters in hypogonadal men with type 2 diabetes but not in men with coexisting depression: the BLAST study. J Sex Med, 2014. 11: 840.

https://pubmed.ncbi.nlm.nih.gov/24308723

33.Wittert, G., et al. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol, 2021. 9: 32.

https://pubmed.ncbi.nlm.nih.gov/33338415

34.Yassin, A., et al. Testosterone Therapy in Men With Hypogonadism Prevents Progression From Prediabetes to Type 2 Diabetes: Eight-Year Data From a Registry Study. Diabetes Care, 2019. 42: 1104.

https://pubmed.ncbi.nlm.nih.gov/30862651

35.Kapoor, D., et al. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol, 2006. 154: 899.

https://pubmed.ncbi.nlm.nih.gov/16728551

36.Hackett, G., et al. Long-term testosterone therapy in type 2 diabetes is associated with reduced mortality without improvement in conventional cardiovascular risk factors. BJU Int, 2019. 123: 519.

https://pubmed.ncbi.nlm.nih.gov/30216622

37.Muraleedharan, V., et al. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol, 2013. 169: 725.

https://pubmed.ncbi.nlm.nih.gov/23999642

38.Hackett, G., et al. Testosterone undecanoate improves sexual function in men with type 2 diabetes and severe hypogonadism: results from a 30-week randomized placebo-controlled study. BJU Int, 2016. 118: 804.

https://pubmed.ncbi.nlm.nih.gov/27124889

39.Corona, G., et al. The Role of testosterone treatment in patients with metabolic disorders. Expert Rev Clin Pharmacol, 2021. 14: 1091.

https://pubmed.ncbi.nlm.nih.gov/34085587

40.Corona, G., et al. THERAPY OF ENDOCRINE DISEASE: Testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol, 2016. 174: R99.

https://pubmed.ncbi.nlm.nih.gov/26537862

41.Saad, F., et al. Differential effects of 11 years of long-term injectable testosterone undecanoate therapy on anthropometric and metabolic parameters in hypogonadal men with normal weight, overweight and obesity in comparison with untreated controls: real-world data from a controlled registry study. Int J Obes (Lond), 2020. 44: 1264.

https://pubmed.ncbi.nlm.nih.gov/32060355

42.Rastrelli, G., et al. Low testosterone levels predict clinical adverse outcomes in SARS-CoV-2 pneumonia patients. Andrology, 2021. 9: 88.

https://pubmed.ncbi.nlm.nih.gov/32436355

43.Salciccia, S., et al. Interplay between male testosterone levels and the risk for subsequent invasive respiratory assistance among COVID-19 patients at hospital admission. Endocrine, 2020. 70: 206.

https://pubmed.ncbi.nlm.nih.gov/33030665

44.Cinislioglu, A.E., et al. The relationship of serum testosterone levels with the clinical course and prognosis of COVID-19 disease in male patients: A prospective study. Andrology, 2022. 10: 24.

https://pubmed.ncbi.nlm.nih.gov/34288536

45.Kadihasanoglu, M., et al. SARS-CoV-2 Pneumonia Affects Male Reproductive Hormone Levels: A Prospective, Cohort Study. J Sex Med, 2021. 18: 256.

https://pubmed.ncbi.nlm.nih.gov/33468445

46.Salonia, A., et al. Severely low testosterone in males with COVID-19: A case-control study. Andrology, 2021. 9: 1043.

https://pubmed.ncbi.nlm.nih.gov/33635589

47.Dhindsa, S., et al. Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19. JAMA Netw Open, 2021. 4: e2111398.

https://pubmed.ncbi.nlm.nih.gov/34032853

48.Lanser, L., et al. Testosterone Deficiency Is a Risk Factor for Severe COVID-19. Front Endocrinol (Lausanne), 2021. 12: 694083.

https://pubmed.ncbi.nlm.nih.gov/34226825

49.Nie, X., et al. Multi-organ proteomic landscape of COVID-19 autopsies. Cell, 2021. 184: 775.

https://pubmed.ncbi.nlm.nih.gov/33503446

50.Dhindsa, S., et al. Association of Male Hypogonadism With Risk of Hospitalization for COVID-19. JAMA Netw Open, 2022. 5: e2229747.

https://pubmed.ncbi.nlm.nih.gov/36053534

51.Corona, G., et al. Andrological effects of SARS-Cov-2 infection: a systematic review and meta-analysis. J Endocrinol Invest, 2022. 45: 2207.

https://pubmed.ncbi.nlm.nih.gov/35527294

52.Turner, H.E., et al. Gonadal function in men with chronic illness. Clin Endocrinol (Oxf), 1997. 47: 379.

https://pubmed.ncbi.nlm.nih.gov/9404435

53.Corona, G., et al. Is late-onset hypogonadotropic hypogonadism a specific age-dependent disease, or merely an epiphenomenon caused by accumulating disease-burden? Minerva Endocrinol, 2016. 41: 196.

https://pubmed.ncbi.nlm.nih.gov/26883937

54.Temiz, M.Z., et al. Investigation of SARS-CoV-2 in semen samples and the effects of COVID-19 on male sexual health by using semen analysis and serum male hormone profile: A cross-sectional, pilot study. Andrologia, 2021. 53: e13912.

https://pubmed.ncbi.nlm.nih.gov/33244788

55.Salonia, A., et al. Testosterone in males with COVID-19: a 12-month cohort study. Andrology, 2023. 11: 17.

https://pubmed.ncbi.nlm.nih.gov/36251583

56.Salonia, A., et al. Testosterone in males with COVID-19: A 7-month cohort study. Andrology, 2022. 10: 34.

https://pubmed.ncbi.nlm.nih.gov/34409772

57.Mohr, B.A., et al. Normal, bound and nonbound testosterone levels in normally ageing men: results from the Massachusetts Male Ageing Study. Clin Endocrinol (Oxf), 2005. 62: 64.

https://pubmed.ncbi.nlm.nih.gov/15638872

58.Grossmann, M., et al. A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management. J Clin Endocrinol Metab, 2017. 102: 1067.

https://pubmed.ncbi.nlm.nih.gov/28359097

59.Millar, A.C., et al. Predicting low testosterone in aging men: a systematic review. CMAJ, 2016. 188: E321.

https://pubmed.ncbi.nlm.nih.gov/27325129

60.Cayan, S., et al. Effect of serum total testosterone and its relationship with other laboratory parameters on the prognosis of coronavirus disease 2019 (COVID-19) in SARS-CoV-2 infected male patients: a cohort study. Aging Male, 2020. 23: 1493.

https://pubmed.ncbi.nlm.nih.gov/32883151

61.Rastrelli, G., et al. Testosterone and Benign Prostatic Hyperplasia. Sex Med Rev, 2019. 7: 259.

https://pubmed.ncbi.nlm.nih.gov/30803920

62.Guay, A., et al. Does early morning versus late morning draw time influence apparent testosterone concentration in men aged > or =45 years? Data from the Hypogonadism In Males study. Int J Impot Res, 2008. 20: 162.

https://pubmed.ncbi.nlm.nih.gov/17637790

63.Travison, T.G., et al. Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe. J Clin Endocrinol Metab, 2017. 102: 1161.

https://pubmed.ncbi.nlm.nih.gov/28324103

64.Gagliano-Juca, T., et al. Oral glucose load and mixed meal feeding lowers testosterone levels in healthy eugonadal men. Endocrine, 2019. 63: 149.

https://pubmed.ncbi.nlm.nih.gov/30191441

65.Huhtaniemi, I.T., et al. Comparison of serum testosterone and estradiol measurements in 3174 European men using platform immunoassay and mass spectrometry; relevance for the diagnostics in aging men. Eur J Endocrinol, 2012. 166: 983.

https://pubmed.ncbi.nlm.nih.gov/22423144

66.Rosner, W., et al. Toward excellence in testosterone testing: a consensus statement. J Clin Endocrinol Metab, 2010. 95: 4542.

https://pubmed.ncbi.nlm.nih.gov/20926540

67.Fiers, T., et al. Reassessing Free-Testosterone Calculation by Liquid Chromatography-Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab, 2018. 103: 2167.

https://pubmed.ncbi.nlm.nih.gov/29618085

68.Vermeulen, A., et al. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab, 1999. 84: 3666.

https://pubmed.ncbi.nlm.nih.gov/10523012

69.Corona, G., et al. Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. Eur Urol, 2017. 72: 1000.

https://pubmed.ncbi.nlm.nih.gov/28434676

70.Boeri, L., et al. Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. J Sex Med, 2017. 14: 1549.

https://pubmed.ncbi.nlm.nih.gov/29198510

71.Antonio, L., et al. Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone. J Clin Endocrinol Metab, 2016. 101: 2647.

https://pubmed.ncbi.nlm.nih.gov/26909800

72.Rastrelli, G., et al. Symptomatic androgen deficiency develops only when both total and free testosterone decline in obese men who may have incident biochemical secondary hypogonadism: Prospective results from the EMAS. Clin Endocrinol (Oxf), 2018. 89: 459.

https://pubmed.ncbi.nlm.nih.gov/29855071

73.Ferlin, A., et al. Management of male factor infertility: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS) : Endorsing Organization: Italian Society of Embryology, Reproduction, and Research (SIERR). J Endocrinol Invest, 2022. 45: 1085.

https://pubmed.ncbi.nlm.nih.gov/35075609

74.Dalvi, M., et al. The prevalence of structural pituitary abnormalities by MRI scanning in men presenting with isolated hypogonadotrophic hypogonadism. Clin Endocrinol (Oxf), 2016. 84: 858.

https://pubmed.ncbi.nlm.nih.gov/26733239

75.Molitch, M.E. Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA, 2017. 317: 516.

https://pubmed.ncbi.nlm.nih.gov/28170483

76.Cipriani, S., et al. Biochemical predictors of structural hypothalamus-pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism. J Endocrinol Invest, 2021. 44: 2785.

https://pubmed.ncbi.nlm.nih.gov/33970435

77.Lincoff, A.M., et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med, 2023. 389: 107.

https://pubmed.ncbi.nlm.nih.gov/37326322

78.Corona, G., et al. Testosterone treatment and cardiovascular and venous thromboembolism risk: what is 'new'? J Investig Med, 2017. 65: 964.

https://pubmed.ncbi.nlm.nih.gov/28495861

79.Gagnon, D.R., et al. Hematocrit and the risk of cardiovascular disease--the Framingham study: a 34-year follow-up. Am Heart J, 1994. 127: 674.

https://pubmed.ncbi.nlm.nih.gov/8122618

80.Corona, G., et al. Consequences of Anabolic-Androgenic Steroid Abuse in Males; Sexual and Reproductive Perspective. World J Mens Health, 2022. 40: 165.

https://pubmed.ncbi.nlm.nih.gov/34169679

81.Colpi, G.M., et al. European Academy of Andrology guideline Management of oligo-astheno-teratozoospermia. Andrology, 2018. 6: 513.

https://pubmed.ncbi.nlm.nih.gov/30134082

82.Corona, G., et al. The pharmacotherapy of male hypogonadism besides androgens. Expert Opin Pharmacother, 2015. 16: 369.

https://pubmed.ncbi.nlm.nih.gov/25523084

83.Mirone, V., et al. European Association of Urology Position Statement on the Role of the Urologist in the Management of Male Hypogonadism and Testosterone Therapy. Eur Urol, 2017. 72: 164.

https://pubmed.ncbi.nlm.nih.gov/28249799

84.Nieschlag, E. Late-onset hypogonadism: a concept comes of age. Andrology, 2020. 8: 1506.

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85.Isidori, A.M., et al. A critical analysis of the role of testosterone in erectile function: from pathophysiology to treatment-a systematic review. Eur Urol, 2014. 65: 99.

https://pubmed.ncbi.nlm.nih.gov/24050791

86.Huo, S., et al. Treatment of Men for "Low Testosterone": A Systematic Review. PLoS One, 2016. 11: e0162480.

https://pubmed.ncbi.nlm.nih.gov/27655114

87.Rastrelli, G., et al. Testosterone Replacement Therapy for Sexual Symptoms. Sex Med Rev, 2019. 7: 464.

https://pubmed.ncbi.nlm.nih.gov/30803919

88.Elliott, J., et al. Testosterone therapy in hypogonadal men: a systematic review and network meta-analysis. BMJ Open, 2017. 7: e015284.

https://pubmed.ncbi.nlm.nih.gov/29150464

89.Corona, G., et al. Androgens and male sexual function. Best Pract Res Clin Endocrinol Metab, 2022. 36: 101615.

https://pubmed.ncbi.nlm.nih.gov/35153145

90.Pencina, K.M., et al. Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism. J Clin Endocrinol Metab, 2024. 109: 569.

https://pubmed.ncbi.nlm.nih.gov/37589949

91.Corona, G., et al. The role of testosterone in male sexual function. Rev Endocr Metab Disord, 2022. 23: 1159.

https://pubmed.ncbi.nlm.nih.gov/35999483

92.Zhu, J., et al. Do testosterone supplements enhance response to phosphodiesterase 5 inhibitors in men with erectile dysfunction and hypogonadism: a systematic review and meta-analysis. Transl Androl Urol, 2020. 9: 591.

https://pubmed.ncbi.nlm.nih.gov/32420164

93.Snyder, P.J., et al. Lessons From the Testosterone Trials. Endocr Rev, 2018. 39: 369.

https://pubmed.ncbi.nlm.nih.gov/29522088

94.Cunningham, G.R., et al. Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels. J Clin Endocrinol Metab, 2016. 101: 3096.

https://pubmed.ncbi.nlm.nih.gov/27355400

95.Nieschlag, E., et al. MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol, 2015. 173: R47.

https://pubmed.ncbi.nlm.nih.gov/25805894

96.Steeves, J.A., et al. Cross-sectional association between physical activity and serum testosterone levels in US men: results from NHANES 1999-2004. Andrology, 2016. 4: 465.

https://pubmed.ncbi.nlm.nih.gov/26991734

97.Lee, T.W., et al. Effects of Testosterone Replacement Therapy on Muscle Strength in Older Men with Low to Low-Normal Testosterone Levels: A Systematic Review and Meta-Analysis. Gerontology, 2023. 69: 1157.

https://pubmed.ncbi.nlm.nih.gov/37494893

98.Rosen, R.C., et al. Quality of Life and Sexual Function Benefits of Long-Term Testosterone Treatment: Longitudinal Results From the Registry of Hypogonadism in Men (RHYME). J Sex Med, 2017. 14: 1104.

https://pubmed.ncbi.nlm.nih.gov/28781213

99.Smith, J.B., et al. Low Serum Testosterone in Outpatient Psychiatry Clinics: Addressing Challenges to the Screening and Treatment of Hypogonadism. Sex Med Rev, 2018. 6: 69.

https://pubmed.ncbi.nlm.nih.gov/29128270

100.Walther, A., et al. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry, 2019. 76: 31.

https://pubmed.ncbi.nlm.nih.gov/30427999

101.Nian, Y., et al. Testosterone replacement therapy improves health-related quality of life for patients with late-onset hypogonadism: a meta-analysis of randomized controlled trials. Andrologia, 2017. 49.

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102.Corona, G., et al. Testosterone Deficiency and Risk of Cognitive Disorders in Aging Males. World J Mens Health, 2021. 39: 9.

https://pubmed.ncbi.nlm.nih.gov/32378366

103.Isidori, A.M., et al. Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. J Endocrinol Invest, 2015. 38: 103.

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104.Corona, G., et al. Testosterone supplementation and body composition: results from a meta-analysis of observational studies. J Endocrinol Invest, 2016. 39: 967.

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105.Traish, A.M. Testosterone and weight loss: the evidence. Curr Opin Endocrinol Diabetes Obes, 2014. 21: 313.

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106.Saad, F., et al. Effects of long-term treatment with testosterone on weight and waist size in 411 hypogonadal men with obesity classes I-III: observational data from two registry studies. Int J Obes (Lond), 2016. 40: 162.

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107.Rochira, V., et al. EAA clinical guideline on management of bone health in the andrological outpatient clinic. Andrology, 2018. 6: 272.

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108.Isidori, A.M., et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf), 2005. 63: 280.

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109.Tracz, M.J., et al. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. J Clin Endocrinol Metab, 2006. 91: 2011.

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110.Corona, G., et al. Testosterone supplementation and bone parameters: a systematic review and meta-analysis study. J Endocrinol Invest, 2022. 45: 911.

https://pubmed.ncbi.nlm.nih.gov/35041193

111.Fan, Y., et al. Diabetes mellitus and risk of hip fractures: a meta-analysis. Osteoporos Int, 2016. 27: 219.

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112.Wang, J., et al. Increased risk of vertebral fracture in patients with diabetes: a meta-analysis of cohort studies. Int Orthop, 2016. 40: 1299.

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113.Ng Tang Fui, M., et al. Effect of Testosterone Treatment on Bone Microarchitecture and Bone Mineral Density in Men: A 2-Year RCT. J Clin Endocrinol Metab, 2021. 106: e3143.

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114.Grossmann, M. Hypogonadism and male obesity: Focus on unresolved questions. Clin Endocrinol (Oxf), 2018. 89: 11.

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115.Corona, G., et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol, 2013. 168: 829.

https://pubmed.ncbi.nlm.nih.gov/23482592

116.Corona, G., et al. Treatment of Functional Hypogonadism Besides Pharmacological Substitution. World J Mens Health, 2020. 38: 256.

https://pubmed.ncbi.nlm.nih.gov/31496147

117.Pasquali R, et al. ESE Clinical Practice Guideline on Endocrine Work-up in Obesity. Eur J Endocrinol 2019.

https://www.ese-hormones.org/publications/directory/ese-clinical-practice-guideline-endocrine-work-up-in-obesity/

118.Rastrelli, G., et al. Pharmacological management of late-onset hypogonadism. Expert Rev Clin Pharmacol, 2018. 11: 439.

https://pubmed.ncbi.nlm.nih.gov/29505313

119.Miller, J.A., et al. Oral testosterone therapy: past, present, and future. Sex Med Rev, 2023. 11: 124.

https://pubmed.ncbi.nlm.nih.gov/36779549

120.Ohlander, S.J., et al. Erythrocytosis Following Testosterone Therapy. Sex Med Rev, 2018. 6: 77.

https://pubmed.ncbi.nlm.nih.gov/28526632

121.Rastrelli, G., et al. Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology, 2014. 2: 794.

https://pubmed.ncbi.nlm.nih.gov/25271205

122.Rogol, A.D., et al. Natesto , a novel testosterone nasal gel, normalizes androgen levels in hypogonadal men. Andrology, 2016. 4: 46.

https://pubmed.ncbi.nlm.nih.gov/26695758

123.Awouters, M., et al. Aromatase inhibitors and selective estrogen receptor modulators: Unconventional therapies for functional hypogonadism? Andrology, 2020. 8: 1590.

https://pubmed.ncbi.nlm.nih.gov/31696669

124.Rambhatla, A., et al. The Role of Estrogen Modulators in Male Hypogonadism and Infertility. Rev Urol, 2016. 18: 66.

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