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convenience of applying an appropriate treatment, but it can prevent physicians from alleviating a patients’ worst-case scenarios. Therefore, physicians should strive to formulate a treatment policy by interpreting the common and different parts among guidelines. In this sense, we truly appreciate the recent informative work by Dr. Salter and Dr. Mulhall where they summarized the guidelines for ‘testosterone therapy for testosterone deficiency (TD)’ [1]. Despite the consensus that the effect of testosterone therapy in TD on several symptoms such as sexual function, whether testosterone therapy is advantageous for some areas associated with TD is still inconclusive among guidelines. Very recently, a guideline for testosterone therapy based on a systematic review supported by the American College of Physicians (ACP) was published [2,3] where the authors recommend testosterone therapy only for enhancing sexual function in TD. When we reviewed the guidelines [3-8], the sources of statements on the efficacy and safety of testosterone therapy on several clinical statuses were different from one another; the range of sources was from a handful of systematic reviews to a well-designed randomized controlled trial. In the European Association of Urology (EAU) guideline [4], the level of evidence and/or the statement of recommendation was documented for the efficacy of testosterone therapy on the relevant TD-related symptom. In the American Urological Association guideline [5], several systematic reviews were incorporated to make a panel discussion for developing the level of evidence as well as a recommendation grade. In the International Society for Sexual Medicine (ISSM) guideline [6], many previous systematic reviews were employed to determine the level of evidence and recommendation grade where all symptomatic TD was recommended to receive testosterone therapy; evidence of the efficacy of testosterone therapy for relevant symptoms was detailed 3 years later by a systematic review published in the Journal of Sexual Medicine [7].

Efficacy and Safety of Testosterone Therapy Based on Guideline Recommendations; Re: Clinical Practice Guideline by the American College of Physicians