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28 July 2015

Long-term testosterone treatment with different testosterone preparations

Long-term testosterone treatment with different testosterone preparations

- provocative results on diagnosis and adherence

Due to lack of consistent clear-cut guidelines for diagnosis and treatment of testosterone deficiency, there is a lot of confusion among both health professionals and suffering men. The multiple different testosterone preparations available further add to the complexity of testosterone treatment.

This editorial presents the intriguing results from a notable study that analyzed effects of testosterone therapy with seven different testosterone preparations, in symptomatic men who had previously been denied treatment because of "normal" baseline testosterone levels. The results are quite provocative and highlight several important practical issues relating to diagnosis and treatment of hypogonadism…

5 September 2014

Effects of testosterone replacement therapy in men with hypogonadism

Effects of testosterone replacement therapy in men with hypogonadism

STUDY: Traish AM. Outcomes of testosterone therapy in men with testosterone deficiency (TD): part II. Steroids. 2014;88:117-126.

Alleged concerns regarding risk of cardiovascular disease with testosterone replacement therapy have been promulgated recently. However, a large and growing number of intervention studies show to the contrary that testosterone therapy reduces cardiovascular risk factors and confers multiple beneficial health effects. Thus, fears promoted by some recent flawed studies need to be critically re-evaluated.

This summary gives an overview of a comprehensive review of studies that have investigated health effects and safety of testosterone therapy. As outlined here, the position that hypogonadism (also known as testosterone deficiency) should be regarded as a risk factor for cardiovascular disease is supported by a rapidly expanding body of evidence.

19 August 2014

Testosterone Treatment and Heart Attack Risk

Testosterone Treatment and Heart Attack Risk

- New study shows testosterone treatment can even be beneficial

Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy. Baillargeon, J., et al., Ann Pharmacother 1060028014539918, first published on July 2, 2014 as doi:10.1177/1060028014539918, 2014

Testosterone therapy has been in use for more than 70 years for the treatment of hypogonadism, also called testosterone deficiency. In the past 30 years there has been a growing body of scientific research demonstrating that testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality. In line with the detrimental health outcomes seen with testosterone deficiency, testosterone therapy has been shown to confer beneficial effects on multiple risk factors and risk biomarkers related to these clinical conditions.

Despite these well-documented health benefits, testosterone therapy is still controversial, in large part due to a few flawed studies about potential elevated heart attack risk with testosterone therapy. On July 2, 2014, a study was published which demonstrated that testosterone therapy is not associated with an increased risk of heart attack, and may actually confer protection against heart attack.

16 July 2014

Testosterone and Prostate Cancer - a paradigm shift

Testosterone and Prostate Cancer - a paradigm shift

"Bye-bye Androgen Hypothesis, Welcome Saturation Model"

A new era of testosterone and prostate cancer: from physiology to clinical implications. Khera M, Crawford D, Morales A, et al., Eur Urol 2014; 65(1): 115-23.

A long-held belief is that testosterone stimulates development of prostate cancer (PCa) and/or accelerates its growth. This summary gives an overview of an in-depth review of current literature regarding the relationship of serum testosterone and PCa and the effect of testosterone replacement therapy (TRT) on PCa progression and recurrence. Key studies which have refuted the old belief that testosterone has harmful effects on the prostate are presented, along the new testosterone-prostate paradigm known as the saturation model.

14 July 2014

Effects of testosterone deficiency on body composition, strength and sexual function in men

Effects of testosterone deficiency on body composition, strength and sexual function in men
This paper presents the findings from a study that looked at the effects of testosterone on body fat, lean mass, thigh-muscle area and strength, and sexual function in healthy men who had their testosterone levels experimentally reduced. As the majority of estradiol (a form of estrogen) is obtained from testosterone, the concomitant decrease in estradiol was also investigated and the effects differentiated from those of testosterone.

19 November 2012

Changes in the worldwide diagnosis and treatment of testosterone deficiency between 2006 and 2010

Diagnosing and treating testosterone deficiency in different parts of the world: changes between 2006 and 2010. Gooren LJ, Behre HM. The Aging Male 2012;15(1):22-27.

This physician-based survey investigated the diagnosis and treatment of testosterone deficiency (hypogonadism) in various parts of the world in 2010. The study, conducted in Germany, Spain, the United Kingdom, Brazil and Saudi Arabia between April and May 2010, involved 353 physicians (229 urologists, 84 endocrinologists and 40 primary care physicians) who were interviewed to address the following issues (1) the reasons to use/not use testosterone in patients who have testosterone deficiency (2) the role of safety and other concerns in the decision to not provide testosterone treatment and (3) to evaluate the actual use of testosterone preparations for the treatment of erectile dysfunction. The results of this survey were compared with a previous survey conducted in Germany, Spain, the United Kingdom, Brazil and South Korea by the same investigators in 2006 to determine if any significant changes in clinical practice have occurred over the last 4 years.

Key Points

  • The majority of physicians surveyed (82%) would regularly use laboratory measurements of total testosterone to diagnose testosterone deficiency
  • Physicians consider the main symptoms of testosterone deficiency to be erectile dysfunction, lack of libido, fatigue, loss of power, depression, weight gain and loss of hair/reduced body hair

    • There was an increased awareness among physicians of depression and weight gain as clinical symptoms of low testosterone
  • For 70% of the physicians surveyed, the severity of the symptoms experienced was considered a more significant reason to start testosterone treatment than the laboratory value of testosterone
  • In 2010, significantly more physicians expressed concern about the adverse effects of testosterone treatment compared with 2006 (78% vs 54%)

    • Eleven percent of patients eligible for testosterone therapy did not receive treatment due to these concerns
  • The proportion of patients diagnosed with erectile dysfunction who have testosterone deficiency ranged from 41% to 63% depending on the country

    • These patients were more likely in 2010 to be treated with phosphodiesterase type 5 (PDE5) inhibitor monotherapy or testosterone plus PDE5 inhibitors than in 2006.

Last updated: 2019