Early initiation of a 5ARI in symptomatic men with enlarged prostates and a PSA level of ≥1.5 ng/mL has been proposed as a reasonable approach to decreasing prostate volume and maintaining the reduction long term (Roehrborn et al. 2004b).
Although there is continuing debate about the best way to diagnose hypogonadism in the aging male, there appears to be a general consensus that symptomatic men with reduced levels of testosterone should be given a trial of testosterone therapy if there is no contraindication to do so (Bain et al 2007).
As men with signs suggestive of S aureus skin or soft tissue infection were thought to be more likely to be infected with MRSA, we also aimed to include a group of 75 symptomatic men.
Another recent study conducted amongst symptomatic adults aged 50 years and over, drawn from the general population in North Staffordshire, England, found a significantly higher proportion of symptomatic men had knee ROA compared to symptomatic women.
To approach the Framingham results, selection bias would need to result in a selective non-participation of symptomatic men without knee ROA, with or without selective non-participation of symptomatic women with knee ROA.
Symptomatic men with a total serum testosterone concentration less that 200 ng/dL are definitely hypogonadal, while those with a concentration between 200 and 300 ng/dL are probably hypogonadal.
Conclusions This study is the first to explore the benefit of treating asymptomatic or mildly symptomatic men with an enlarged prostate.
In the meantime, truly hypogonadal men (those who are symptomatic men and have a serum testosterone concentration below 200 ng/dL) who have no contraindications to testosterone replacement therapy (eg, prostate cancer) may benefit from testosterone replacement regardless of whether they are 30 or 80 years of age.
The guidelines also allow diagnosis of gonorrhoeal urethritis in symptomatic men based only on a Gram stain of the male urethral specimen and a demonstration of the presence of polymorphonuclear leukocytes with intracellular Gram-negative diplococci.
When this analysis was restricted to studies of symptomatic men only, there was a greater difference in efficacy in favour of doxycycline (efficacy difference of 5.5 %; 95 % CI: −1.4 %, 12.4 %).
