Potential benefits and harms of testosterone supplementation in men with testosterone deficiency syndrome*,17,18
| Organ system | Benefits | Harms |
|---|---|---|
| Erectile function/libido | Improvement | None |
| Depression/mood/fatigue | Improvement | Aggressive behaviour |
| Erythropoiesis | Increase in hematocrit | Increased risk of polycythemia, embolism |
| Skeletal muscle | Increase in fat-free mass | None |
| Bone metabolism | Prevention of osteoporosis | None |
| Cardiovascular system | Improvement in congestive heart failure, exercise capacity | Increased risk of thromboembolic cardiovascular events |
| Prostate | ||
| Benign prostatic hyperplasia | None beyond manifestations of testosterone deficiency syndrome | Marginal increase in volume and prostate-specific antigen level |
| Cancer (metastatic or high risk of recurrence) | Absolute contraindication | Recurrence and rapid progression |
| Cancer (localized and treated) | None beyond manifestations of testosterone deficiency syndrome | Potential exacerbation of subclinical residual cancer |
| Testicle | None beyond manifestations of testosterone deficiency syndrome | Atrophy or impairment of spermatogenesis |
↵* For additional details on the strength of the evidence, see Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150033/-/DC1).