Long-term Testosterone Therapy Research Articles

Remission of Type 2 Diabetes in 12% (16 of 133) Hypogonadal Men Receiving Long-Term Testosterone Therapy in a Real-Life Registry Study

Background: According to 2016 AACE/ACE obesity guidelines, hypogonadism should be assessed and treated in indicated in men with type 2 diabetes mellitus (T2DM). Methods: In a registry of hypogonadal men (testosterone ≤12.1 nmol/L) conducted since 2004 in a urological setting, 133/400 patients (33.3%) had T2DM diagnosed and treated in a diabetes center. All men received testosterone undecanoate (TU) injections 1000 mg/12 weeks (T-group) following an initial 6-week interval. Anthropometric and metabolic parameters were measured at least twice a year and fasting insulin obtained from the diabetes center to calculate HOMA-IR. Results: Mean follow-up was 6.9, maximum 11 years. 16 patients (12%) were in remission at the last measurement. Their average baseline age was 60.1 years. HbA1c dropped from 8.3% at baseline to 5.7% at the last measurement, fasting glucose from 7.8 mmol/L to 5.4 mmol/L. Fasting insulin declined from 24.7 to 7.6 µU/mL. HOMA-IR dropped from 8.7 to 1.8. Triglycerides decreased from 3.2 to 2.2 mmol/L. Anthropometric parameters: Body weight declined progressively from 107 to 89 kg, waist circumference from 1to 97 cm. All patients had been on oral antidiabetic medication (metformin) at baseline. Five patients were on insulin at an average dose of 21.6 units per day. The average observation time was 106.3 months (8.9 years). The average time to discontinuation of diabetes medication was 74.8 months (6.2 years). One patient was diagnosed with low-grade prostate cancer and developed new onset T2DM while off TU. He went into remission 48 months after resuming TU therapy. Medication adherence to TU was 100 per cent as all injections were administered in the urology office and documented. Discussion: The registry was not designed to study the effects of testosterone on T2DM. Remission of T2DM has not been described in the literature and was unexpected. Conclusions: Long-term testosterone treatment in hypogonadal men may result in remission of T2DM. Disclosure A. Haider: Research Support; Self; Bayer AG. K.S. Haider: Other Relationship; Self; Bayer AG. F. Saad: Employee; Self; Bayer AG. Stock/Shareholder; Self; Bayer AG, Novo Nordisk A/S.

Abstract #601 Mortality; Major Adverse Cardiovascular Events (Mace) and Weight are Reduced in 400 Hypogonadal Men on Long-Term Testosterone Therapy (TTH) Compared to 376 Untreated Hypogonadal Controls: Real-Life Data from A 10-Year Registry

Abstract #601 Mortality; Major Adverse Cardiovascular Events (Mace) and Weight are Reduced in 400 Hypogonadal Men on Long-Term Testosterone Therapy (TTH) Compared to 376 Untreated Hypogonadal Controls: Real-Life Data from A 10-Year Registry

Abstract #1216 Improvement of Blood Pressure (Bp); Heart Rate and Other Hemodynamic Markers in Hypogonadal Patients with Hypertension Receiving Long-Term Testosterone Therapy (Tth) Compared to Untreated Hypogonadal Controls: Real-Life Data from a 10-Year Registry

Abstract #1216 Improvement of Blood Pressure (Bp); Heart Rate and Other Hemodynamic Markers in Hypogonadal Patients with Hypertension Receiving Long-Term Testosterone Therapy (Tth) Compared to Untreated Hypogonadal Controls: Real-Life Data from a 10-Year Registry

Incidence and severity of prostate cancer (PCa) in 792 hypogonadal men with and without long-term testosterone therapy (TTh): Results from a controlled registry study.

167 Background: There is no evidence that TTh in hypogonadal men increases PCa incidence or severity. A US-Scandinavian group recently found that men receiving TTh had lower risk of aggressive PCa (Loeb S et al., J Clin Oncol 2017; 35:1430-6). Methods: 412 men with testosterone ≤350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 12 years. 380 hypogonadal men (57-74) opted against TTh. Median follow-up: 9 years. Total observation time covered approximately 6,400 patient-years. Prostate volume (PV) and PSA were measured and digital rectal examination/transrectal ultrasound performed before treatment/observation initiation and then every 3-6 months (T-group) or once or twice per year (CTRL). Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, 11 men (2.7%) were diagnosed with PCa. In CTRL, 34 (8.9%) were diagnosed with PCa. The incidence per 10,000 years was 33 in the T-group and 108 in CTRL. The mean baseline age of PCa patients was 65.2 years in the T-group and 64.3 in CTRL. All PCa diagnoses in the T-group were made within the first 18 months of treatment initiation. In CTRL, PCa was diagnosed at any time during the observation time. In the T-group, radical prostatectomy was performed in all men. All but 1 patient had a Gleason score (GS) ≤6, and all but 1 a predominant GS of 3. Tumor grade was G2 in all 11 (100%), tumor stage T2a in 7 (64%), T2b in 3 (27%), and T2c in 1 (9%) patient(s). In CTRL, radical prostatectomy was performed in all but 6 patients. GS was > 6 in all 34 patients. 7 men had a GS of 7, 17 a GS of 8, and 10 a GS of 9. 2 men had a predominant Gleason score of 3, 22 had 4, and 10 had 5. Tumor grade was G2 in 6 (17.6%) and G3 in 28 (82.4%) patients, tumor stage T2c in 1 (0.3%), T3a in 3 (8.8%), T3b in 13 (38.2%) and T3c in 17 (50%) patients. In CTRL, biochemical recurrence occurred in 8 (23.5%) patients. These patients received androgen deprivation therapy (ADT). 10 (29.4%) patients died of whom 5 were on ADT. In the T-group, there were no biochemical recurrences or deaths during the observation time. Conclusions: In hypogonadal men, TTh may decrease PCa incidence compared to CTRL. PCa was less severe in the T-group.

105 Improvement of Type 2 Diabetes (T2DM) in Hypogonadal Men receiving Long-term Testosterone Therapy: Real-life Evidence from a 10-registry Study in a Urological Office

105 Improvement of Type 2 Diabetes (T2DM) in Hypogonadal Men receiving Long-term Testosterone Therapy: Real-life Evidence from a 10-registry Study in a Urological Office

001 Urinary and Sexual Function in 411 Obese Hypogonadal Men with and without Testosterone Therapy: Real-life Evidence from a 10-registry Study in a Urological Office

Obesity negatively affects urinary and erectile function. We investigated effects of long-term testosterone therapy (TTh) from a registry including an untreated hypogonadal control group. 267 obese men with testosterone ≤350 ng/dL and symptoms of hypogonadism received testosterone undecanoate 1000 mg every 3 months following an initial 6-week interval for up to 10 years. 174 hypogonadal men opted against testosterone therapy (TTh). Urinary function was assessed subjectively by IPSS and objectively by ultrasound-measured post-voiding residual bladder volume (RBV), erectile function by IIEF-EF. Differences between groups were estimated and adjusted for age and metabolic syndrome parameters to account for baseline differences between groups. Mean age: 61±6 years (T-group: 60±6, CTRL: 64±5). IPSS decreased from 7.4±3.8 to 1.9±0.7 (p<0.0001) at 10 years in the T-group and from 4.9±1.8 to 4.3±3.7 (NS) in CTRL, estimated adjusted between-group difference: -4.4 (p<0.0001). RBV decreased from 55±22 to 10±2 mL (p<0.0001) at 10 years in the T-group and increased from 52±15 to 58±23 mL (p<0.05) in CTRL, estimated adjusted between-group difference: -56 mL (p<0.0001). IIEF-EF increased from 19.1±5.2 to 27.1±1.6 at 10 years in the T-group and decreased from 19.4±3.6 to 9±2 in CTRL, estimated adjusted between-group difference: +19.2 (p<0.0001 for all).

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Jan 2018This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.09.138AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Development and validation of objective performance metrics for robot-assisted radical prostatectomy: a pilot study. J Urol2018; 199: 296. Link, Google Scholar 2 : Comparative analysis of partial gland ablation and radical prostatectomy to treat low and intermediate risk prostate cancer: oncologic and functional outcomes. J Urol2018; 199: 140. Link, Google Scholar 3 : Which patients with upper tract urothelial carcinoma can be safely treated with flexible ureteroscopy with holmium:YAG laser photoablation? Long-term results from a high volume institution. J Urol2018; 199: 66. Link, Google Scholar 4 : Surgical and patient reported outcomes of artificial urinary sphincter implantation: a multicenter, prospective, observational study. J Urol2018; 199: 245. Link, Google Scholar 5 : Predictors of infectious complications after targeted prophylaxis for prostate needle biopsy. J Urol2018; 199: 155. Link, Google Scholar 6 : A comprehensive analysis of cribriform morphology on magnetic resonance imaging/ultrasound fusion biopsy correlated with radical prostatectomy specimens. J Urol2018; 199: 106. Link, Google Scholar 7 : Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery. J Urol2018; 199: 206. Link, Google Scholar 8 : Retroperitoneal lymphadenectomy for high risk, nonmetastatic renal cell carcinoma: an analysis of the ASSURE (ECOG-ACRIN 2805) adjuvant trial. J Urol2018; 199: 53. Link, Google Scholar 9 : Long-term testosterone therapy improves urinary and sexual function, and quality of life in men with hypogonadism: results from a propensity matched subgroup of a controlled registry study. J Urol2018; 199: 257. Link, Google Scholar 10 : Five-year followup results of a prospective, multicenter study of patients with overactive bladder treated with sacral neuromodulation. J Urol2018; 199: 229. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 1January 2018Page: 1-3 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Remission of type 2 diabetes in a hypogonadal man under long-term testosterone therapy.

In daily practice, clinicians are often confronted with obese type 2 diabetes mellitus (T2DM) patients for whom the treatment plan fails and who show an inadequate glycemic control and/or no sustainable weight loss. Untreated hypogonadism can be the reason for such treatment failure. This case describes the profound impact testosterone therapy can have on a male hypogonadal patient with metabolic syndrome, resulting in a substantial and sustained loss of body weight, pronounced improvement of all critical laboratory values and finally complete remission of diabetes.Learning points:Hypogonadism occurs frequently in men with T2DM.In case of pronounced abdominal fat deposition and T2DM, the male patient should be evaluated for testosterone deficiency.Untreated hypogonadism can complicate the successful treatment of patients with T2DM.Under testosterone therapy, critical laboratory values are facilitated to return back to normal ranges and even complete remission of diabetes can be achieved.

Long-Term Testosterone Therapy Improves Urinary and Sexual Function, and Quality of Life in Men with Hypogonadism: Results from a Propensity Matched Subgroup of a Controlled Registry Study.

We investigated the effects of long-term testosterone therapy on urinary and sexual function, and quality of life in hypogonadal men. We performed an observational, prospective, cumulative registry study in 656 men with a mean ± SD age of 60.7 ± 7.2 years who had total testosterone 12.1 nmol/l or less and symptoms of hypogonadism. In the testosterone treated group 360 men received parenteral testosterone undecanoate 1,000 mg/12 weeks for up to 10 years. The 296 men who elected against testosterone therapy served as controls. From each group 82 patients were propensity matched by age, waist circumference and body mass index, resulting in 82 matched pairs of 164 men. Data were analyzed and estimated differences between the groups were adjusted for components of metabolic syndrome and quality of life. We found significant decreases in I-PSS (International Prostate Symptom Score) and post-void bladder volume (each p <0.0001) in patients receiving testosterone therapy but not in the untreated group. We recorded a decrease in AMS (Aging Males' Symptoms Scale) in the testosterone treated group but not in the untreated group (p <0.0001). We also recorded significant improvement in the IIEF-EF (International Index of Erectile Function-Erectile Function) domain in the testosterone treated group but not in the untreated group (p <0.0001). The improvement was maintained throughout followup. Long-term testosterone therapy in hypogonadal men resulted in significant improvements in urinary and sexual function, and in quality of life. In untreated hypogonadal men voiding and erectile function deteriorated with continued followup.

Prostate cancer (PCa) in 696 hypogonadal men with and without long-term testosterone therapy (TTh): Results from a controlled registry study.

5085 Background: There is no evidence that TTh in men with hypogonadism increases PCa incidence or severity. A Canadian group recently found that long-term TTh decreased the risk of PCa diagnosis (Wallis et al., Lancet Diab Endocrinol 2016; 4:498). We assessed incidence and severity of PCa in hypogonadal men on long-term TTh (T-group) in comparison to an untreated hypogonadal control group (CTRL). Methods: 400 men with testosterone ≤350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 10 years. 296 hypogonadal men (57-74) opted against TTh. Median follow-up: 8 years. Total observation time covered more than 5,000 patient-years. Prostate volume (PV), PSA, weight and C-reactive protein (CRP) were measured and digital rectal examination/transrectal ultrasound performed before treatment initiation and then every 6-12 months. Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, PV increased slightly but significantly by 2.41 mL (p &lt; 0.0001), PSA by 0.22 (NS). In CTRL, PV decreased slightly but significantly by -1.20 mL (p &lt; 0.005), PSA by -0.38 (p &lt; 0.0001). Weight dropped by 18.23% in the T-group and increased by 1.78% in CTRL, CRP decreased significantly in the T-group and remained unchanged in CTRL. In the T-group, 9 men (2.3%) were diagnosed with PCa. In CTRL, 15 (5.1%) were diagnosed with PCa. The incidence per 10,000 years was 29 in the T-group and 102 in CTRL. The mean baseline age of PCa patients was 65 years in the T-group and 65.5 in CTRL. Prostatectomy was performed in all men. In the T-group, all but 1 patient had a Gleason score ≤6, and all a predominant Gleason score of 3. Tumor grade was G2 in all 9 (100%), tumor stage T2a in 7 (78%) and T2b in 2 (22%) patients. In CTRL, Gleason score was &gt; 6 in all 15 patients. 4 men had a predominant Gleason score of 3, 10 had 4, and 1 had 5. Tumor grade was G2 in 7 (46.7%) and G3 in 8 (53.3%) patients, tumor stage T2b in 1 (6.7%), T2c in 1 (6.7%), T3a in 1 (6.7%), T3b in 7 (46.7%) and T3c in 6 (50%) patients. Conclusions: In hypogonadal men, TTh may decrease PCa incidence compared to CTRL. PCa was less severe in the T-group. Weight loss and reduced inflammation by TTh may have contributed to our findings.

MP91-14 CARDIOVASCULAR DISEASE (CVD), HYPOGONADISM & ED: POSITIVE EFFECTS UNDER LONG-TERM TREATMENT WITH TESTOSTERONE UNDECANOATE INJECTIONS (TU)

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2017MP91-14 CARDIOVASCULAR DISEASE (CVD), HYPOGONADISM & ED: POSITIVE EFFECTS UNDER LONG-TERM TREATMENT WITH TESTOSTERONE UNDECANOATE INJECTIONS (TU) Dany-Jan Yassin, Aksam Yassin, Karim Haider, and Ahmad Haider Dany-Jan YassinDany-Jan Yassin More articles by this author , Aksam YassinAksam Yassin More articles by this author , Karim HaiderKarim Haider More articles by this author , and Ahmad HaiderAhmad Haider More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2854AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ED is a predictive risk factor for CVD. We monitored effectiveness and safety of long-term Testosterone Therapy (TTh) in hypogonadal men with a history of CVD. METHODS Two observational registry studies of 622 hypogonadal men from two urological centers: 77 men with a previous diagnosis of coronary artery disease (CAD; n=48) and/or a myocardial infarction (MI; n=40) and/or stroke (n=7) received TU for up to 8 years. RESULTS Mean age was 60.65 ± 4.98 years, mean follow-up time was 7.29 ± 1.20 years. Testosterone (T) levels rose from 9.78 ± 1.56 nmol/L to trough levels (measured prior to the following injection) between 16 and 18 nmol/L. IIEF-EF (maximum score: 30) increased from 19.64 ± 6.34 to 24.49 ± 4.69 with a change from baseline of 5.37±0.36, this improvement was statistically significant for the first three years and remained statistically significant vs baseline throughout the observation time and stable compared to previous years. Weight decreased progressively from 114.47 ± 13.41 to 90.42 ± 8.77 by 23.6 ± 0.6 kg, proportion of weight loss: 19.62 ± 5.71%. Waist circumference decreased from 111.78±8.22 to 99.24 ± 6.48 by 12.51 ±0.37 cm. The waist:height ratio improved from 0.64 ± 0.05 to 0.57 ± 0.04 (p<0.0001 for all). Blood pressure (BP, mmHg): Systolic BP decreased from 164.45 ± 14.4 to 132.96 ± 8.71, diastolic BP from 99.48 ± 11.37 to 76.39 ± 4.89, pulse pressure from 64.97 ± 6.48 to 56.57 ± 8.02 (p<0.0001 for all). Lipid pattern and glycaemic control improved significantly and sustainably. C-reactive protein (CRP) declined from 3.69 ± 4.51 to 0.25 ± 0.28 mg/dl. In no patient was testosterone therapy discontinued or interrupted. No cardiovascular events were reported during the observation time. CONCLUSIONS In hypogonadal men with a history of CVD, T therapy may improve and preserve erectile function for a prolonged period of time. No cardiologic or urologic events observed during entire period of T therapy. TTh appears to be well-tolerated and safe © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1223 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dany-Jan Yassin More articles by this author Aksam Yassin More articles by this author Karim Haider More articles by this author Ahmad Haider More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP91-11 POSITIVE EFFECTS OF LONG-TERM TREATMENT WITH TESTOSTERONE UNDECANOATE INJECTIONS (TU) ON RENAL FUNCTION IN HYPOGONADAL MEN: REAL-LIFE DATA FROM A PROSPECTIVE CONTROLLED REGISTRY STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2017MP91-11 POSITIVE EFFECTS OF LONG-TERM TREATMENT WITH TESTOSTERONE UNDECANOATE INJECTIONS (TU) ON RENAL FUNCTION IN HYPOGONADAL MEN: REAL-LIFE DATA FROM A PROSPECTIVE CONTROLLED REGISTRY STUDY Aksam Yassin, Dany-Jan Yassin, Gheorge Doros, and Abdulmaged Traish Aksam YassinAksam Yassin More articles by this author , Dany-Jan YassinDany-Jan Yassin More articles by this author , Gheorge DorosGheorge Doros More articles by this author , and Abdulmaged TraishAbdulmaged Traish More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A registry was established to assess long-term effectiveness and safety of testosterone undecanoate injections (TU) in a urological setting in comparison to an untreated hypogonadal control group. Parameters related to renal function were measured to gain insight on effects of testosterone therapy (TTh) on renal function. METHODS Observational, prospective, cumulative registry study in 505 men (age: 61.4 ± 9.7 years) with total testosterone (T) levels ≤350 ng/dL and symptoms of hypogonadism. 321 men received parenteral TU 1000 mg/12 weeks following an initial 6-week interval for up to 12 years (T-group). 184 men had opted against TTh and served as controls (CTRL). 8-year data were analyzed. Renal profile was assessed by (Creatinine, Urea, Uric acid and Glomerular filtration rate measured according to Mayo Clinic setting) RESULTS Creatinine decreased from 1.14±0.18 to 1.07±0.8 mg/dL in the T-group and increased from 0.99±0.25 to 1.13±0.53 in CTRL. Uric acid decreased from 6.8±1.5 to 5.5±1.6 mg/dL in the T-group (p<0.0001) and from 5.7±1.5 to 5.2±1.5 mg/dL in CTRL (p<0.01). Urea was only available for the T-group and decreased from 47.5±12.0 to 31.7±12.9 mg/dL (p<0.0001). Glomerular filtration rate (GFR) increased from 86.6±12.8 to 98.5±8.6 mL/min/1.73 m2 in the T-group and decreased from 90.8±20.2 to 87.0±26.0 mL/min/1.73 m2 in CTRL (p<0.0001 for both). γ-GT decreased from 39.31±11.62 to 28.95±7.57 U/L in the T-group (p<0.0001) and increased from 37.79±29.55 to 39.5±26.71 U/L in CTRL (p<0.0005). Bilirubin decreased from 1.64±4.13 to 1.21±1.89 mg/dL in the T-group (p<0.05) and increased from 1.04±7.08 to 1.12±1.96 mg/dL in CTRL (NS). AST remained stable in both groups, ALT declined slightly in both groups. Medication adherence in the T-group was 100 per cent as all injections were administered in the office and documented. There were 25 deaths (7.8%) in the T-group of which 11 (44%) were cardiovascular. In CTRL, 28 patients (15.2%) died, and all deaths (100%) were attributed to cardiovascular causes. CONCLUSIONS Long-term TTh with TU in an unselected hypogonadal men resulted in improvement of renal function, whereas there was a slight worsening in untreated controls. Since renal function may be related to cardiovascular risk, the observed changes may have contributed to a reduction in mortality. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1222 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Aksam Yassin More articles by this author Dany-Jan Yassin More articles by this author Gheorge Doros More articles by this author Abdulmaged Traish More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

RigiScan data under long-term testosterone therapy: improving long-term blood circulation of penile arteries, penile length and girth, erectile function, and nocturnal penile tumescence and duration

Background: Late-onset hypogonadism (LOH) presents with low serum testosterone (TT) levels and sexual and nonsexual symptoms. Erectile dysfunction affects a man’s self-esteem and as a result partner relationship and quality of life.Objectives: To investigate the andrological clinical profile outcomes of testosterone therapy (TTh) in men (n = 88) with symptomatic LOH complaints and symptoms.Main outcome measures: Erectile function was assessed using the International Index of Erectile Function-5 questionnaire at baseline and at 6 and 12 months of TTh. In addition, penile length was measured at baseline and 12 months. We also evaluated nocturnal penile tumescence (NPT, using RigiScan) and blood flow of cavernous arteries (penile Doppler ultrasonography) at baseline and 12 months of TT.Materials and methods: Eighty-eight LOH men (Mage 51.1 years) with erectile dysfunction, all with serum TT <10.4 nmol/L before TTh. Patients received intramuscular long-acting testosterone undecanoate for 12 months.Results: Following TTh, in all patients, serum TT levels were restored within 3 months to normal levels. Compared with baseline values, erectile function significantly improved at 6 (mean score increase 1.95) and 12 months (mean score increase 2.16). No significant changes in penile length were observed. NPT significantly improved at 12 months in terms of both the frequency (mean increase 1.27 times) and duration of rigidity (mean increase 5.12 min). As regards the blood flow of the cavernous arteries, we observed a significant improvement (decrease of 1.16 cm/s) and end diastolic velocity of the penile arteries.Conclusion: TTh in men with LOH resulted in improvement of the erectile function, NPT, and to some extent the blood flow of the cavernous arteries.

Effects of long-term testosterone therapy on obesity, glycaemic control and other features of the metabolic syndrome

Effects of long-term testosterone therapy on obesity, glycaemic control and other features of the metabolic syndrome

Men with testosterone deficiency and a history of cardiovascular diseases benefit from long-term testosterone therapy: observational, real-life data from a registry study.

Background/objectivesLong-term testosterone therapy (TTh) in men with hypogonadism has been shown to improve all components of the metabolic syndrome. In this study, we investigated the effects of long-term TTh up to 8 years in hypogonadal men with a history of cardiovascular disease (CVD).Patients and methodsIn two urological clinics observational registries, we identified 77 hypogonadal men receiving TTh who also had a history of CVD. The effects of TTh on anthropometric and metabolic parameters were investigated for a maximum duration of 8 years. Any occurrence of major adverse cardiovascular events was reported. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals.ResultsIn 77 hypogonadal men with a history of CVD who received TTh, we observed a significant weight loss and a decrease in waist circumference and body mass index. Mean weight decreased from 114±13 kg to 91±9 kg, change from baseline: −24±1 kg and −20.2%±0.5%. Waist circumference decreased from 112±8 cm to 99±6 cm, change from baseline: −13±0.3 cm. Body mass index decreased from 37±4 to 29±3, change from baseline: −8±0.2 kg/m2. Cardio-metabolic parameters such as lipid pattern, glycemic control, blood pressure, heart rate, and pulse pressure all improved significantly and sustainably. No patient suffered a major adverse cardiovascular event during the full observation time.ConclusionIn men with hypogonadism, TTh appears to be effective in achieving sustained improvements in all cardiometabolic risk factors and may be effective as an add-on measure in the secondary prevention of cardiovascular events in hypogonadal men with a history of CVD.

Abstract #512: Is Long-Term Testosterone Therapy Effective in Secondary Prevention of Major Adverse Cardiovascular Events (MACE) in Hypogonadal Men with a History of Cardiovascular Disease (CVD)? Real-Life Data from a Registry Study

Abstract #512: Is Long-Term Testosterone Therapy Effective in Secondary Prevention of Major Adverse Cardiovascular Events (MACE) in Hypogonadal Men with a History of Cardiovascular Disease (CVD)? Real-Life Data from a Registry Study

PD07-11 DURATION OF TESTOSTERONE THERAPY AND MALE AGE PREDICT TIME TO RETURN OF NORMAL TOTAL MOTILE SPERM COUNT AFTER HUMAN CHORIONIC GONADOTROPIN THERAPY

INTRODUCTION AND OBJECTIVES: Testosterone therapy (TTh) reduces sperm counts in men. For men with testosterone-associated azoospermia and severe oligospermia, treatment includes TTh cessation and human chorionic gonadotropin (hCG) therapy. However, optimal duration of hCG therapy needed for sperm recovery or the expected extent of sperm recovery remains unknown. We identify factors affecting the length of time needed for sperm recovery and for sperm counts to reach >5 million/mL after TTh and subsequent hCG therapy. METHODS: Retrospective chart review of men seen at a single academic andrology clinic between 2004-2015 was performed. All included patients presented with infertility, were on TTh at the time of the visit, and had an initial semen analysis with azoospermia or severe oligospermia. Men ceased TTh and were started on hCG, and had a second semen analysis within 6 months of starting hCG. The number of men with total motile sperm count (TMC) >5 million was determined. Logistic regression analysis evaluated the relationship between the number of men with TCM >5 million and time on TTh, age, T formulation, treatment with or without clomiphene citrate, initial T level, and initial sperm count. RESULTS: A total of 55 men were identified with a mean age of 40.0 (range 27-69) years and a mean duration of TTh of 42.0 (range 0.5-240) months. Of the 55 men, 36 (65.5%) achieved a TMC of >5 million within 6 months of stopping TTh and starting hCG. Two variables had a strong associations with the likelihood of achieving TMC >5 million: age (p 1⁄4 0.04) and time on TTh (p 1⁄4 0.01). T formulation, initial T level, initial sperm count, and clomiphene citrate use were not significantly associated. Multivariate logistic regression demonstrated that both time on TTh (OR1⁄40.781, p1⁄40.016) and patient age (OR1⁄40.941, p1⁄40.050) decrease the probability of achieving a TMC >5 million within 6 months (Figure 1). CONCLUSIONS: Men with infertility associated with TTh can resume sperm production adequate for initiating pregnancy by IUI using hCG combined therapy. The likelihood of achieving sufficient sperm counts within 6 months of TTh cessation and initiation of hCG is related to patient age and duration of TTh. Clinicians should counsel older men or men on long-term TTh that recovery of spermatogenesis may be slower than in other men.

MP47-07 PREDIABETES, HYPOGONADISM & ERECTILE DYSFUNCTION: GLYCAEMIC CONTROL IN 109 HYPOGONADAL MEN TREATED WITH TESTOSTERONE UNDECANOATE INJECTIONS (TU) FOR UP TO 8 YEARS: REAL-LIFE DATA FROM REGISTRY STUDIES

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation1 Apr 2016MP47-07 PREDIABETES, HYPOGONADISM & ERECTILE DYSFUNCTION: GLYCAEMIC CONTROL IN 109 HYPOGONADAL MEN TREATED WITH TESTOSTERONE UNDECANOATE INJECTIONS (TU) FOR UP TO 8 YEARS: REAL-LIFE DATA FROM REGISTRY STUDIES Aksam Yassin, Ahmad Haider, Karim Haider, Gheorghe Doros, Abdulmaged Traish, and Farid Saad Aksam YassinAksam Yassin More articles by this author , Ahmad HaiderAhmad Haider More articles by this author , Karim HaiderKarim Haider More articles by this author , Gheorghe DorosGheorghe Doros More articles by this author , Abdulmaged TraishAbdulmaged Traish More articles by this author , and Farid SaadFarid Saad More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.326AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testosterone therapy (TRT) has been studied in hypogonadal men with type 2 diabetes mellitus (T2DM). However, there is no information on effects of TRT in hypogonadal men with prediabetes. Our aim was to study erectile function in hypogonadal men with prediabetes. METHODS From two registries of hypogonadal men receiving long-term TRT with TU, 109 men with prediabetes, defined as a baseline HbA1c from 5.7 to 6.4%, were analysed. TU was administered in 3-month intervals for up to 8 years. At each or each other visit, questionnaires were applied and anthropometric and metabolic parameters were measured. RESULTS Mean age was 57.37 ± 8.99 years. Total testosterone increased from 8.55 ± 2.14 to trough levels between 16 and 19 nmol/L. Mean IIEF-EF (maximum score: 30) improved from 13.04 ± 6.3 to 22.55 ± 4.74. The improvement was statistically significant for three years and remained statistically significant vs baseline throughout the observation time, and stable compared to previous years. Weight decreased from 96.15 ± 13.05 to 84.14 ± 6.98 kg by -14 ± 0.65%, waist circumference from 103.8 ± 6.88 to 94.32 ± 4.53 cm by -9.62 ± 0.44 cm (p<0.0001 for both). Fasting glucose decreased from 5.43 ± 0.68 to 4.63 ±0.67, change from baseline -0.94 ± 0.11 mmol/L reaching a plateau after 1 year. HbA1c decreased from 5.9 ± 0.21 to 5.38 ± 0.26%, change from baseline -0.59 ± 0.04% with statistical significance compared to the previous year for the first 3 years. The triglyceride:HDL ratio, considered a surrogate parameter of insulin resistance, declined from 5.62 ± 2.61 to 2.6 ± 0.74 (p<0.0001 for all). No patient progressed from prediabetes to T2DM. All but 4 patients′ last HbA1c was <5.7%. 3 patients dropped out, 2 due to relocation to a different city, 1 was lost to follow-up. There were no major adverse cardiovascular events during the full observation time. CONCLUSIONS Hypogonadal men with prediabetes showed clinically meaningful and sustainable weight loss and improvements in glycaemic control upon long-term TU treatment. No patient advanced from prediabetes to T2DM. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e629 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Aksam Yassin More articles by this author Ahmad Haider More articles by this author Karim Haider More articles by this author Gheorghe Doros More articles by this author Abdulmaged Traish More articles by this author Farid Saad More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of continuous long-term testosterone therapy (TTh) on anthropometric, endocrine and metabolic parameters for up to 10years in 115 hypogonadal elderly men: real-life experience from an observational registry study.

Subnormal levels of testosterone are associated with significant negative health consequences, with higher risks of all-cause and cardiovascular mortality. The numbers of studies reporting on the benefits of normalisation of testosterone is increasing but longer-term data on (elderly) men receiving testosterone treatment are almost nonexistent. In this single-centre, cumulative, prospective, registry study, 115 hypogonadal men (mean age 59.05years) received injections with testosterone undecanoate in 12-week intervals for up to 10years. Waist circumference, body weight and mean BMI dropped progressively with statistical significance versus previous year for 7years and, respectively, 8years for weight and body mass index. Similarly, fasting glucose displayed a significant decrease after the first year continuing to decrease thereafter. A decline in HbA1c , from 6.4% to 5.6% (mean <6%), was observed from year 2 on, together with a decrease in the ratio of triglycerides:high-density lipoprotein (HDL), a surrogate marker of insulin resistance, with an increase in HDL levels. The total cholesterol:HDL ratio and non-HDL cholesterol declined significantly. A decrease was also observed in systolic and diastolic blood pressure, with a decrease in levels of the inflammation marker C-reactive protein. No major adverse cardiovascular events were observed throughout the study.

Different Medications for Hypogonadotropic Hypogonadism.

Delayed puberty (DP) in boys is the lack of sexual maturation at a chronological age of 14 years. Several conditions induce DP and they can be classified into reversible and irreversible causes. The most common cause of DP is constitutional delay of puberty (CDP; 63%), followed by DPs due to functional hypogonadotropic hypogonadism (HH; 20%), congenital isolated HH (9%) and hypergonadotropic hypogonadism (7%). A correct diagnosis, although often difficult, is pivotal for choosing the most adequate therapy. In CDP boys, expectant management can be an option. However, patient's psychological distress can be attenuated by short-term low-dose testosterone therapy, which can induce male secondary sexual characteristics. When therapy is discontinued in CDP, pubertal development continues similarly to normal boys. Long-term testosterone therapy is the only option in boys with DP due to hypergonadotropic hypogonadism, whereas in subjects with HH, besides long-term testosterone, also gonadotropins and gonadotropin-releasing hormone (GnRH) can be used. Gonadotropins and GnRH, besides inducing secondary sexual characteristics, can also induce testicular maturation and spermatogenesis. Other molecules, such as kisspeptin and neurokinin B agonists, are now under evaluation as new therapeutic options for treating DP.