Hypogonadal men that start on testosterone therapy can experience benefit on various aspects of their lives. Most of them will have an improvement in sexual function if they have any problem, they will see a reduction in fat mass, they can improve metabolism so they can improve symptoms or signs of metabolic syndrome, but if I have to summarize just in a single statement what happens to hypogonadal men starting on testosterone is that they improve their lives. They improve motivation, they improve performance, they improve functional promoting activity.
Testosterone has many effects on the whole body, and depending on what you are looking for, it can take different times to achieve the maximum benefits. Some of the effects are very immediate, so you experience a change in sexual function even within a few weeks of starting the treatment, but for other effects – for example the body composition, the bone metabolism, the strength, the improvement in metabolic function – they can take months or years, and this is very important to stress, to be stressed to the patient in order that he can have the sufficient patience and wait in order to get all the effects achieved. So yes, there are differences between short- and long-term treatment, and the long-term effects are much more significant and relevant to the general health of the patient, so you have to wait.
Hypogonadal men with type 2 diabetes can experience an improvement when they start testosterone treatment. The effects are slow progressive, so it takes time to achieve that kind of changes, and it can be either a reduction in the burden of medication they have to take, or even if the treatment is long enough, they can also take out some of the medication that were given to treat diabetes.
In my own experience, testosterone treatment is very, very safe. I’m treating hundreds of patients now so I have a large experience, and I will say the only side effect I have experienced is the increase in red blood cells, so the polycythemia, that can occur I have to say in sensitive patients, so it’s not a general phenomenon. Some patients, very few, I would say 1%, can experience an increase in red blood count, and that is not anyway a dramatic event because you just stop the treatment, and then just restarting the medication at the lower dose can in most of the cases be sufficient to keep an adequate improvement of the benefits and avoiding the repetition of this increase in the hematocrit.
For a significant number of patients, testosterone treatment is a treatment that has been given for lifelong, and in that respect it’s very important to give testosterone in the way that is impacting less on the quality of life of our patients. In my experience, I treat a lot of young subjects. The long injections are the best effective. So the Nebido or the testosterone undecanoate injection in my experience are those who are having the lower dropout rate.
I would recommend measuring testosterone in all patients with sexual dysfunction of any kind, so either low libido or erectile dysfunction. I will measure testosterone in all obese subjects, in all obese men, especially if they have some traits of the metabolic syndrome, and I will definitely measure testosterone in all subjects receiving long-term opioids or medication that can affect the liver function, for example.
There are many, many data now upcoming regarding the benefits and the safety of testosterone use. There are many recent large trials, well-performed, well-controlled. Actually, the amount of data we have is even more than what is the knowledge on how to use testosterone, and many countries have now developed their own guidelines that are however a little bit influenced from politics or local realities. For example, there are some significant differences from the American Endocrine Society guidelines compared to the Australian guidelines or even the Italian guidelines, but in the next year there will be out the guidelines from the European Academy of Andrology, so it will be the first European consensus on how to treat testosterone in a sovereign region or sovereign country statement. So we are looking forward to have these guidelines in order to clarify and to solve some of the discrepancies that appears from the different guidelines.
Prof. Dr. med. Marija Pfeifer Medical Faculty University of Ljubljana, Slovenia