Androgen Replacement Therapy In Men Research Articles

Androgen replacement therapy in men: current evidence and controversy

The decline in Testosterone (T) levels in the ageing male - known as andropause or late-onset hypogonadism - may be responsible for several aspects of quality of life decline in older men: erectile dysfunction, impaired libido, decreased strength and energy, sarcopenia, osteopenia, fatigue and even depression in some cases. Many of these signs and symptoms represent the same alterations that are usually attributed to the process of ageing. When some individual presents with such symptoms, hypogonadism should be suspected, and serum T level should be evaluated. Men who are symptomatic and present low levels of serum Testosterone (generally below 300 ng/ml) are candidates for T replacement therapy. Current evidence shows that, when correctly selected, patients receiving T replacement may benefit from improvement in libido, erectile function, overall and sexual related quality of life, bone density and muscle mass. Conversely, patients with physiological circulating levels of T who receive hormone, aiming at supraphysiologic levels, may face severe side effects, including testicular atrophy and behavioral changes. Of note, T replacement, regardless of age and pre-therapy levels, leads to fertility impairment which can be transient or persistent. Direct testosterone replacement should not be indicated in men who wish to conceive children, although other options are available. The effect of Testosterone replacement on prostate cancer and on cardiovascular risk is still controversial; hypogonadal men known to have prostate cancer or high cardiovascular risk should be examined individually to have their risks stratified and mitigated.

Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

Hypogonadism in men, defined as a reduction in serum testosterone in combination with characteristic symptoms and/or signs (described in detail later), is common in diabetes mellitus (DM). These recommendations do not cover the whole range of pathologies that cause the development of testosterone deficiency (hypogonadism), but focus on its clinical variants and characteristic for men with diabetes. The recommendations provide data on the prevalence of hypogonadism in diabetes, its etiology. In the section "diagnostics" the features of anamnesis of patients with hypogonadism with diabetes, the necessary methods of physical and laboratory examination are presented in detail. The risk factors and clinical consequences of hypogonadism are separately examined. In the section "choice of treatment methods", there are possible treatment options for such patients using various androgenic therapies, taking into account the needs of the man, maintaining his reproductive function and risk factors. Particular attention is paid to indications, contraindications and risk factors for androgen therapy in men with diabetes, especially in old age. With this in mind, principles for monitoring the treatment are developed. Based on a large number of studies, favorable effects of androgen replacement therapy in men with hypogonadism and diabetes have been demonstrated.

Testosterone and cardiovascular risk: myths and new truth about cardiological safety of androgen replacement therapy in men

Testosterone and cardiovascular risk: myths and new truth about cardiological safety of androgen replacement therapy in men

The efficacy of androgen replacement therapy in men with late-onset hypogonadism

Background Late-onset hypogonadism (LOH) is defined as subnormal serum testosterone (T) levels in connection with an array of physical, psychic and sexual symptoms, generally related to male hypogonadism. Recent studies show that it is generally recognized that serum T, in normal range, has important roles for prevention of the onset of adult disease such as diabetes mellitus. Therefore, we have actively provided LOH patients with androgen replacement therapy (ART). Objective The objective of this study was to clinically assess the efficacy and side effects of ART in men with LOH. Methods The study included 64 patients diagnosed with LOH and treated with ART at least as long as 6 months at our institution. Questionnaires with age, aging male symptom (AMS) scale, and androgen decline in the aging male (ADAM) were examined. Fasting blood samples were analyzed for sex hormones, total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides (TG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GTP), red blood cell count (RBC), hemoglobin (Hb), hematocrit (Ht), prostate-specific antigen (PSA) and plasma glucose. Results Psychological and physical symptoms scores, measured by the AMS scale and the ADAM questionnaire, were significantly improved after ART ( P < 0.05). TC, HDL and LDL cholesterol, TG, AST, ALT, γ-GTP, and plasma glucose were not significantly different before and after the therapy. Conclusions ART for men with LOH may cause favorable changes in psychological and physical conditions. However, further investigations are necessary to determine long-term effects of the therapy.

Testosterone: use, misuse and abuse

Testosterone is among the oldest drugs in medicine. It has a long efficacy and safety record for its prime role of androgen replacement therapy in men with androgen deficiency. Testosterone and synthetic analogue androgens have also been used in pharmacological androgen therapy (PAT) to produce androgenic effects on marrow, muscle or bone. Although PAT is increasingly being superseded by newer, more expensive drugs, androgens remain cost-effective in many older applications. Androgen misuse is the systematic over-prescribing for unproven medical indications. Misuse is increasingly evident for male ageing ("andropause") and some other clinical conditions. Further trials for new indications for androgens require reliable safety data, but rising costs may make it increasingly attractive to circumvent the need for evidence by promoting off-label mass marketing. Androgen abuse is the illicit self-administration of often massive doses of androgens for non-medical purposes - notably power sports and body building. In parallel with effective detection reducing androgen abuse in elite sports, more focus is needed on non-sporting cosmetic, recreational and occupational androgen abuse. Despite ongoing androgen misuse and abuse, testosterone remains under-prescribed for younger men with classical androgen deficiency that frequently remains undiagnosed.

Ageing male and testosterone: Current status and treatment guidelines

Because the decline in androgens is generally gradual and not a complete deficiency, clinical significance of this decline is still unclear, and there is controversy as to whether a specific syndrome of androgen deficiency or 'andropause' exists. The term andropause or androgen deficiency in aging males (ADAM) underwent revisions to, partial androgen deficiency in aging male (PADAM), late onset hypogonadism (LOH) and now symptomatic late onset hypogonadism (SLOH), signifying, the evolving nature of this phenomenon. Since this happens at a time of life, when many men have associated comorbities, it's difficult to assess the exact impact of androgen decline, due to which, the issues surrounding androgen replacement therapy in men with symptomatic late-onset hypogonadism have been marred in controversy. Although with age, a decline in testosterone levels will occur in virtually all men, there is no way of predicting, who, will experience andropausal symptoms of sufficient severity and also long-term safety data on testosterone administration in this setting, is lacking.<b> </b> This article will focus on the controversies and practices of androgen replacement.

Testosterone treatment for the aging man: The controversy

The issues surrounding androgen replacement therapy in men with symptomatic late-onset hypogonadism has been marred in controversy even before the identification and synthesis of testosterone. The controversy has attained renewed importance because of the ever increasing aging population. Physicians attuned with the various diagnostic approaches, familiar with the advantages and drawbacks of testosterone preparations, and aware of the potential safety issues are well positioned to deal with the hypogonadal man at or beyond middle age. The urologist is in a unique position to assist patients and colleagues in other specialties, particularly in relation to prostate safety. This update focuses on the most prominent areas of controversy.