The ISA sponsored a 3 hour panel discussion, "The controversies on diagnosis, treatment and monitoring of acquired or late onset hypogonadism" with audience participation at the 4th World Congress on the Aging Male, Prague, Sunday, February 29, 2004. The panel chairs were E. Nieschlag (Germany) and R. Swerdloff (USA) and the panel members included J.M. Kaufman (Belgium), F. Wu (UK), A. Morales (Canada), H. Behre (Germany), C. Wang (USA), L. Gooren (Netherlands), J. Morley (USA), J.J. Legros (Belgium), B. Lunenfeld (Israel). The goal of the panel is 1) to discuss the current understanding and controversy of the clinical syndrome of androgen deficiency in aging male and the potential treatment with androgens and 2) to review and determine whether ISA in collaboration with ISSAM should develop recommendations or guidelines for the diagnosis, treatment and monitoring of hypogonadism associated with aging in men. Each panel member was asked to review the Institute of Medicine Report on Testosterone and Aging (The National Academic Press, Washington DC, February 2004) and to introduce a topic followed by comments/discussion by panel members with a 45-minute general discussion by participants at the end of the panel discussions.

Drs. Swerdloff and Nieschlag introduced the topic by indicating the lack of consensus on diagnosis and treatment of this condition. There is considerable interest shown by influential agencies in the US such as the National Institutes of Health (NIH); Food and Drug Administration (FDA), Institute of Medicine (IOM) and international agency such as the World Health Organization (WHO) on the topic. Dr. Kaufman discussed the problems with the diagnosis of late onset male hypogonadism. Dr. Wu then reviewed the other hormone systems that were associated with aging that might contribute to the symptoms of the aging male. Dr. Morales introduced the topic of exclusion criteria for testosterone treatment and indicated that cancer of the prostate, breast cancer and bladder obstructive symptoms were clear exclusion criteria. Dr. Behre discussed the different modalities of T treatment. Dr. Wang followed by discussing the monitoring of T treatment. Dr. Gooren discussed role of weight reduction and exercise as non-pharmacologic treatment or prevention of age-related hypogonadism. Dr. Morley reviewed the issues of T as a cause of erectile dysfunction in aging men. Dr. Legros then described the "Liege Aging Male Program".

General discussion that followed included: salivary T measurements, "metabolic syndrome", cardiovascular risks, sleep apnea, hCG treatment amongst others. The plan was for the Chairs to draft a revision of the ISSAM recommendations and circulate to panelists. These recommendations can be published by the panel as individuals, circulated to the ISA member societies and discussed again at the ISA 2005 Congress in Seoul, Korea.

Christina Wang, MD, USA