Care of Patients with Male Hypogonadism: A Joint Position Statement from SBEM, SBU, and ABEMSS

Brazil's three major societies align on hypogonadism diagnosis and TRT — first multidisciplinary consensus for the country

Journal: International Brazilian Journal of Urology | Published: 2026 | Type: Practice Guideline | PMID: 41678706 Authors: Hohl A, Lopes L, Ronsoni MF, Miranda EP, Fighera TM, Facio FN, Marchesan LB, Torres LO (UFSC, ABC Faculty of Medicine, UFRGS, FAMERP, and others — broad institutional representation across Brazil) Funding/COI: Funding not listed. No conflicts of interest declared.

Summary

Brazilian clinical practice for male hypogonadism has been fragmented, with no prior unified national guidance. This joint position statement from endocrinology, urology, and sexual medicine societies fills that gap, recommending morning total testosterone confirmation plus gonadotropin assessment for diagnosis and preferring long-acting intramuscular or transdermal testosterone formulations for treatment. It explicitly addresses functional hypogonadism driven by obesity and anabolic-androgenic steroid (AAS) use — a nod to real-world epidemiology that many older guidelines underweight.

Claims

• Diagnosis requires morning total testosterone confirmation and gonadotropin (LH/FSH) assessment — not a single lab draw
• Rising obesity, metabolic syndrome, and AAS use in Brazil are driving increased rates of functional (as opposed to organic) hypogonadism
• Testosterone replacement therapy (TRT) is recommended for confirmed organic hypogonadism
• Preferred formulations are long-acting intramuscular or transdermal preparations
• Fertility-preserving alternatives — selective estrogen receptor modulators (SERMs), human chorionic gonadotropin (hCG), and aromatase inhibitors — are specifically addressed for men who want to maintain reproductive function
• The document claims to reduce both underdiagnosis and overtreatment

Study Quality

This is a consensus position statement, not primary research. No original patient data were collected, no systematic review protocol is described in the abstract, and no formal evidence-grading methodology (e.g., GRADE) is mentioned. The quality of the recommendations depends entirely on how rigorously the authors synthesized existing evidence — information not available from the abstract alone. Multi-society authorship broadens the perspective but does not substitute for transparent methodology.

As a practice guideline, it cannot be evaluated by the same standards as a clinical trial. What matters is whether the underlying evidence is cited, graded, and honestly characterized — which requires reading the full document.

Red Flags

• No evidence-grading framework described; unclear how strong vs. weak recommendations are distinguished
• Funding source not disclosed — the publication process and any related activities may have industry involvement that isn't surfaced
• Scoped to Brazil's healthcare system; international applicability is limited by formulary and access differences
• Functional hypogonadism guidance (obesity-related, AAS-induced) is clinically contested territory — recommendations here may outpace the evidence base
• Conclusions section reads more like an advocacy statement than a methodological summary

Strengths

• First multidisciplinary Brazilian guideline harmonizing endocrinology, urology, and sexual medicine — fills a genuine gap
• Addresses functional hypogonadism explicitly, including AAS-induced suppression, which is commonly underserved in legacy guidelines
• Fertility preservation is integrated rather than treated as an afterthought
• Multi-institutional authorship spanning multiple regions of Brazil reduces single-center bias
• Aims to standardize a field where heterogeneous practice is documented

Verdict

A consensus guideline is only as good as its evidence synthesis, and this paper doesn't reveal enough of its methodology to assess that. What it does do is put three major Brazilian societies on the same page for the first time — which, if the underlying evidence citations are rigorous, is genuinely useful for clinicians operating in a fragmented landscape. The functional hypogonadism focus is timely given obesity rates. Read the full text to see how they grade their own recommendations before treating this as authoritative; the abstract alone is a press release, not a methodology.