Testosterone Replacement Therapy In Older Men Research Articles

EMAS position statement: Testosterone replacement therapy in older men.

Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in ageing men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased cardiovascular morbidity and mortality risk. Although testosterone replacement therapy (TRT) reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of TRT in older men is debatable. To update the 2015 EMAS statement on TRT in older men with new research on late-onset hypogonadism and TRT. Literature review and consensus of expert opinion. TRT should be offered only to symptomatic older men with confirmed low testosterone concentrations after explaining the uncertainties regarding the long-term safety of this treatment. TRT may be offered to men with severe hypogonadism and erectile dysfunction to improve sexual desire, erectile, and orgasmic function. It should also be considered in hypogonadal men with severe insulin resistance or pre-diabetes mellitus. TRT may also be considered, in combination with proven treatment strategies, for osteoporosis, or for selected patients with persistent mild depressive symptoms and/or low self-perceived quality of life, combined with standard medical care for each condition. TRT is contraindicated in hypogonadal men actively seeking fertility treatment. Due to a lack of data, TRT should not be routinely used in older men to improve exercise capacity/physical function, improve cognitive function, or prevent cognitive decline. TRT must be avoided in older, frail men with known breast cancer or untreated prostate cancer and all men who have had myocardial infarction or stroke within the last four months, and those with severe or decompensated heart failure. The quality of evidence regarding patients with previous prostate cancer or cardiovascular disease is too low to draw definitive conclusions. Any limits on duration of use are arbitrary, and treatment should continue for as long as the man feels the benefits outweigh the risks for him, and decisions must be made on an individual basis. Withdrawal should be considered when hypogonadism is reversed after the resolution of underlying disorder. Short-acting transdermal preparations should be preferred for TRT initiation in older men, but injectable forms may be considered subsequently. Older men on TRT should be monitored at 3, 6, and 12months after initiation and at least yearly thereafter, or earlier and more frequently if indicated. Evaluation should include assessment of the clinical response, and measurement of total testosterone, haematocrit, and prostate-specific antigen (PSA) concentrations. Bone density and/or quality should also be assessed. Obese and overweight patients should be encouraged to undergo lifestyle modifications, including exercise and weight loss, to increase endogenous testosterone.

Effects of Testosterone Replacement Therapy on Muscle Strength in Older Men with Low to Low-Normal Testosterone Levels: A Systematic Review and Meta‐Analysis

Background: Previous studies and meta-analyses have explored the relationship among testosterone, muscle strength, and physical function, to the best of our knowledge, no meta-analysis has investigated the effects of testosterone replacement therapy (TRT) on subgroup of relatively hypogonadal older men. Objective: The aim of this study was to evaluate the effect of TRT in older men with low testosterone levels. Methods: PubMed, Embase, and Web of Science were systematically searched for articles published between January 1990 and April 2020. We included randomized controlled studies that investigated the effect of TRT and included older men (age >60 years) with relatively low testosterone levels. Studies were extracted following the PRISMA flowchart, and the included randomized controlled trials were evaluated using RoB 2.0. Our main outcome was muscle strength changes after TRT evaluated using a metaregression of confounding factors. Secondary outcomes included changes in physical performance and the risk ratio of adverse events. Random-effects meta-analyses of TRT on muscle strength and physical function were performed. Results: Thirteen studies with 2,043 patients were included. The mean age of subjects in various studies ranged from 65.9 years to 76 years. Transdermal testosterone dosages ranged from 5 to 10 g/day, while intramuscular options were 125 mg/week or 200 mg every 2 weeks. Oral testosterone supplementation was given at 160 mg/day in one study. Pooled meta‐analyses revealed greater muscle strength improvement after TRT compared with placebo (Hedges’ g = 0.21; 95% CI: = 0.15–0.28). Intramuscular administration of TRT had greater efficacy (Hedges’ g = 0.74; 95% CI: = 0.34–1.14) than transdermal and oral TRT (p < 0.001). A metaregression revealed that baseline serum total testosterone was associated with muscle strength improvement (β = −0.004, p = 0.002). The risk ratios of adverse events, including elevated prostate-specific antigen, acute coronary syndrome, and prostate cancer, were not significantly different. Conclusion: TRT improved muscle strength in older, relatively hypogonadal men. The effect was more pronounced in populations with lower baseline testosterone levels.

New ideas in urology: 2014 update

Pharmacists practicing in a variety of settings should be aware of the most recent findings on medications used in urology. Hot topics include safety concerns about testosterone replacement therapy (TRT), novel treatments for overactive bladder, and daily dosing of phosphodiesterase-5 enzyme (PDE) inhibitors for erectile dysfunction (ED).

Abstract 19261: The Association Between Testosterone Replacement Therapy and Adverse Cardiovascular Outcomes in Veterans Undergoing Coronary Angiography

Background: Adverse cardiac events were not demonstrated in randomized controlled trials of testosterone replacement therapy (TRT) in men until 2009 when the Testosterone in Older Men with Mobility Limitations trial was halted due to increased cardiac events in the treatment group. Therefore, the safety of TRT in older men with medical comorbidities is under debate. Methods: We used the VA CART-CL registry to identify all veterans undergoing coronary angiography between 2005 and 2011 who had total testosterone levels ≤ 250 ng/dL measured post-procedure. We derived a propensity-matched (2:1) cohort of patients dispensed TRT to patients not dispensed TRT. Multivariable Cox regression assessed the association between TRT and myocardial infarction (MI) or death treating TRT as a time varying covariate. We also evaluated this association within strata of CAD: no CAD, nonobstructive CAD (&gt;20% stenosis in any vessel), and obstructive CAD (≥ 70% in any vessel or ≥ 50% in the left main). Results: Of the 3,375 veterans who had a total testosterone level ≤ 250, 461 (12%) were initiated on TRT after a mean of 546 days (median 463 days) after coronary angiography. No significant differences were observed in the baseline characteristics of the TRT and non-TRT propensity matched groups including mean age (61), hypertension (89%), diabetes (55%), and mean testosterone level (166). In multivariable analyses, there was a significant interaction between TRT and CAD strata (p=0.04). Among veterans with no CAD or nonobstructive CAD, there was no association between TRT and MI/death (p=0.46 and p=0.3, respectively). Among those with obstructive CAD, TRT was associated with significantly increased risk of MI/death (HR 2.51; 95% CI 1.6 - 3.94). Conclusion: In this cohort of veterans undergoing coronary angiography with low testosterone levels, TRT can be associated with increased risk of MI/death as compared to no TRT. This risk appears to be present in patients with obstructive CAD but not among patients with less severe CAD. These findings may have potential implications for targeting testosterone use among selected patient populations.

Testosterone-replacement therapy in older men with limited mobility: is it safe?

Reproductive endocrinology: Testosterone-replacement therapy in older men with limited mobility: is it safe?