MP40-05 DIAGNOSIS AND MANAGEMENT OF TESTOSTERONE DEFICIENCY - COMPARISON OF CURRENT GUIDELINES
Bibliographic record
Abstract
You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP40)1 Apr 2019MP40-05 DIAGNOSIS AND MANAGEMENT OF TESTOSTERONE DEFICIENCY - COMPARISON OF CURRENT GUIDELINES Jethro C.C. Kwong*, Yonah Krakowsky, and Ethan Grober Jethro C.C. Kwong*Jethro C.C. Kwong* More articles by this author , Yonah KrakowskyYonah Krakowsky More articles by this author , and Ethan GroberEthan Grober More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556097.43986.deAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Testosterone deficiency (TD) is characterized by low levels of testosterone (T) with associated signs and symptoms. Several controversies related to approach to TD have been identified. We compare current guidelines for the diagnosis and management of TD, as well as special considerations for specific patient populations. METHODS: The following guidelines were included for analysis: American Urological Association (AUA, 2018), European Association of Urology (EAU, 2018), Endocrine Society (ES, 2018), and Canadian Medical Association (CMAJ, 2015). The comparison focused on the biochemical definition (cut-off) for low T, principles of management of TD, and recommendations for patients with low-to-normal total testosterone, prostate cancer, or cardiovascular disease. RESULTS: Recommendations are generally consistent across guidelines, however there are notable differences (Table 1). For biochemical cut-off, most guidelines require 2 lab measurements of total T ranging between 8 to 10.4 nmol/L, however the CMAJ requires only one measurement and has no specific cut-off. In patients with low-to-normal total T, additional hormonal evaluation is recommended, however only the CMAJ suggests a 3-month trial of TTh in symptomatic patients. The ES has the strictest recommendations for patients with TD and prostate cancer. Other guidelines generally recommend against TTh in patients with metastatic prostate cancer. Although there is limited evidence linking TTh and risk of cardiovascular events (MI, stroke, sudden CV death), the AUA and EAU impose more restrictions in offering TTh to patients with cardiovascular disease. Notably, the AUA recommends against TTh if patients experienced a cardiovascular event within the past 3-6 months, while the EAU states that TTh is contraindicated in patients with NYHA Class IV heart failure. In contrast, the CMAJ recommends TTh in patients with stable cardiovascular disease. CONCLUSIONS: While there is consensus among current guidelines on TD, notable differences may impact diagnosis and eligibility for TTh. Additional work is needed to consolidate recommendations across guidelines, especially for specific patient populations. We highlight the limitations of relying exclusively on guidelines in managing patients with TD. Source of Funding: None Toronto, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e587-e588 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jethro C.C. Kwong* More articles by this author Yonah Krakowsky More articles by this author Ethan Grober More articles by this author Expand All Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.038 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.005 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".