Testosterone Supplementation Therapy Research Articles

The Effect of Testosterone Replacement on Sexual Function in the Elderly: A Systematic Review and Meta-Analysis.

Healthy aging is an important concern in an aging society. Although the causal relationship between hypogonadism and erectile dysfunction in elderly men remains unclear, many physicians have achieved positive results after implementing exogenous testosterone supplementation therapy in patients with normal or slightly low blood testosterone. The purpose of this study was to conduct a systematic review and meta-analysis on whether testosterone replacement therapy (TRT) could improve sexual function in the elderly, as reported recently. As a comprehensive literature search was performed to find articles published in PubMed, Embase, and Cochrane databases by January 2022. The search used keywords of 'aged', 'male', 'sexual behavior', and 'testosterone'. Randomized controlled trials (RCTs) were finally selected. As the main effect variable, results of a questionnaire on sexual function were analyzed and the effects of TRT were compared to those of placebo control. Five RCT studies were included in this meta-analysis. The overall improvement by mean difference of sexual function for testosterone supplementation was 0.082 (95% CI: -0.049 to 0.213). In subgroup analysis, only intramuscular injection of 1,000 mg testosterone significantly improved sexual function of the elderly (0.229, 95% CI: 0.112 to 0.347). There was no significant difference in sexual function according to testosterone dose in meta-ANOVA (p=0.957). The difference was not statistically significant either in the meta-regression test (p=0.310). Egger's regression coefficient test did not indicate a publication bias (p=0.132). Although our overall effect size (that is, sexual function effect of TRT) did not show a significant improvement, the direction of improvement in erection and motivation was clearly shown. The injection formulation resulted in a significant sexual function improvement. Since only a few RCTs were included in the analysis, more well-designed prospective studies are needed to have a definite conclusion.

Testosterone Replacement Therapy in the Aged Male: Monitoring Patients' Quality of Life Utilizing Scoring Systems.

Hypogonadism has been associated with significant deterioration of well-being. In the aging male, late-onset hypogonadism affects sexual life, mental health, levels of energy, lower urinary tract symptoms and, therefore, quality of life may be found significantly deteriorated. Testosterone replacement or supplementation therapy has been found efficient to reverse the adverse effects of hypogonadism and improve quality of life. Scales and questionnaires assessing the general health, urinary symptoms, sexual health, and cognition can provide a thorough assessment of the clinical syndrome, optimize treatment, assist the follow-up, and facilitate referrals to other specialties depending on the chief complaint. A systematic assessment might combine several tools, but the optimal ones and the exact usage is unknown. In this narrative review, we are flipping through the literature presenting the available tools per domain for the assessment of quality of life in men on testosterone replacement therapy and we discuss the optimal usage.

Post-orgasmic illness syndrome accompanied with testosterone deficiency: a case report

Post-orgasmic illness syndrome (POIS) is a rare disease that affects the quality of life of patients. Here, we report a case of a 27-year-old man who visited our clinic and presented with physical fatigue, muscle weakness, emotional irritability, memory difficulties, lack of attention, and flu-like state after ejaculation. The patient was diagnosed with POIS accompanied by testosterone deficiency (TD) and treated with antiallergic therapy combined with testosterone supplementation therapy (TST) and selective serotonin reuptake inhibitor (SSRI). After 3 months of medication, the patient’s POIS symptoms, testosterone levels, and relevant questionnaire scores significantly improved. Antiallergic therapy combined with TST and SSRI treatment can effectively treat patients with POIS accompanied by TD.

Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment

Simple SummaryImpaired cognition can be a late effect after treatment in long-term testicular cancer survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very-long-term survivors after treatment. In this study, we enrolled testicular cancer survivors with a follow-up duration ≥ 20 years—and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular damage and aging parameters. We included 184 testicular cancer survivors (66 chemotherapy patients, 53 radiotherapy patients, and 65 orchiectomy only patients) and 70 healthy controls. The median follow-up was 26 years. Testicular cancer survivors performed worse on cognitive tests compared to controls. In univariate analysis, the presence of hypogonadism was associated with lower cognitive scores. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment.Background: Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls. Methods: In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)—with a follow-up duration ≥ 20 years—and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs). Results: We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20–42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score −0.85; 95% CI −1.39 to −0.33) compared to controls (mean 0.67; 95% CI −0.21 to 1.57, p < 0.01). In univariate analysis, the presence of hypogonadism (β −1.50, p < 0.01), high c-PWV (β −0.35, p = 0.09), and high AGEs (β −1.27, p = 0.02) were associated with lower cognitive scores, while only AGEs (β −1.17, p = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, p < 0.01). Conclusions: Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment. Trial Registration: NCT02572934.

MP31-09 THROMBOEMBOLIC RISK WITH THE USE OF TESTOSTERONE THERAPY IN KLINEFELTER SYNDROME

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-09 THROMBOEMBOLIC RISK WITH THE USE OF TESTOSTERONE THERAPY IN KLINEFELTER SYNDROME Sophie Birch, Andreas Espehana, Yamini Kailash, Paul Caroll, Awatul El-Shirif, Leila Frodsham, Mona Salman, Paula Allchorne, Fredrick Melling, Charlotte Tomlinson, and Tet Yap Sophie BirchSophie Birch More articles by this author , Andreas EspehanaAndreas Espehana More articles by this author , Yamini KailashYamini Kailash More articles by this author , Paul CarollPaul Caroll More articles by this author , Awatul El-ShirifAwatul El-Shirif More articles by this author , Leila FrodshamLeila Frodsham More articles by this author , Mona SalmanMona Salman More articles by this author , Paula AllchornePaula Allchorne More articles by this author , Fredrick MellingFredrick Melling More articles by this author , Charlotte TomlinsonCharlotte Tomlinson More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.09AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Klinefelter Syndrome (KS) is the most prevalent chromosomal disorder in men, defined by having 1 or more extra X chromosome. Literature suggest that there is an increased risk of thromboembolic events in men with KS, with a cumulative incidence of deep vein thrombosis (DVTs) of 8.6% by the age of 50, though the exact mechanism is not known. Testosterone supplementation therapy (TT) is one of the main treatment for KS patients, and this may further increase their risk of thrombotic event. This study was done to assess the impact of testosterone therapy on the incidence of thromboembolism in KS patients. METHODS: Prospectively collected data from March 2017 to January 2020 across a national-access KS multidisciplinary & endocrine clinics from a large tertiary teaching hospital was analysed. In parallel, a community based survey was carried out with the national Klinefelter Association (KSA). Information on thromboembolism incidence, testosterone supplementation use, and population characteristics was collated to compare outcomes between testosterone-treated and untreated KS patients. Ethics approval was obtained for the study. RESULTS: A total of 235 patients were found from the survey & databases and were included in the study, of which there were 79 patients receiving some form of TT (Treated), and 156 not receiving TT (Untreated). 24 (30.4%) of Treated and 17 (10.9%) Untreated men had at least one thromboembolic event (p<0.001). Within these groups, 7 (8.9%) Treated and 7 (4.5%) Untreated men experienced a recurrence. Deep vein thrombosis (DVT) was the most common form of thromboembolism, accounting for 11 (45.8%) of Treated men, and 4 (23.5%) of Untreated men. The length of TT for Treated men who did experience a thromboembolic event was known for 22 out of 24 (91.7%) men. Men on TT for >24 months prior to 1st thromboembolic event represented the majority (70.8%, n=17) of the Treated group’s thromboembolisms. CONCLUSIONS: This study showed higher incidence of thromboembolic events in KS patients on testosterone therapy compared to untreated groups. Further observational studies will be crucial for understanding the impact of TT in KS and should consider the wide range of environmental factors that may contribute to thromboembolism, as well as specific data testosterone intervention. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e558-e558 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sophie Birch More articles by this author Andreas Espehana More articles by this author Yamini Kailash More articles by this author Paul Caroll More articles by this author Awatul El-Shirif More articles by this author Leila Frodsham More articles by this author Mona Salman More articles by this author Paula Allchorne More articles by this author Fredrick Melling More articles by this author Charlotte Tomlinson More articles by this author Tet Yap More articles by this author Expand All Advertisement Advertisement Loading ...

Long-term Opioids Linked to Hypogonadism and the Role of Testosterone Supplementation Therapy.

Opioids play a pivotal role in managing chronic pain with increasing prescription rates over the last few years. Hence, it is crucial to focus on the adverse effects of narcotics, and one of the lesser-known side effects is hypogonadism. Opioids act on the hypothalamus, pituitary, and directly on the gonads affecting serum testosterone levels. Narcotic-induced androgen insufficiency contributes to sexual dysfunction, infertility, hyperalgesia, and involving various body functions overall, affecting the quality of life. Opioid-induced hypogonadism is very challenging to diagnose for the clinicians, as the patients often under-report the symptoms. There are no established guidelines to analyze androgen insufficiency and dealing with their manifestations successfully. We did a substantial search in PubMed and Google Scholar, using various combinations of keywords to collect data to evaluate the impacts of opioids on serum testosterone levels. This study aims to highlight the clinical significance of opioid-induced androgen deficiency and the diagnostic techniques to recognize and credible treatment alternatives, including testosterone replacement therapy. Health care providers should screen the patients routinely for the signs and symptoms and monitor them often for the hormonal changes to select the patients cautiously for testosterone replacement therapy.

SAT-046 Insulin-Like Growth Factor and Fibroblast Growth Factor 21 in Men with Klinefelter Syndrome

Background: Men with 47, XXY Klinefelter syndrome (KS) commonly present with obesity, metabolic disorders, and insulin insensitivity. The insulin-like growth factor (IGF) system has pleiotropic effects including regulation of glucose metabolism. Fibroblast growth factor 21 (FGF21) is associated with weight loss and favourable metabolic changes, but patients with obesity or type 2 diabetes might be resistant to this effect despite presenting with increased levels. Aim: To describe levels of components in the IGF system and FGF21 among men with KS, either treated or not treated with testosterone supplementation therapy (TT), in comparison with control males. Methods: A total of 66 men with KS were included, 33 without current TT and 33 with current TT. A control group of 70 healthy age-matched males were included. Serum levels of insulin-like growth factor 1 (IGF-1), insulin-like growth factor-binding protein 3 (IGFBP3), pregnancy-associated plasma protein A (PAPP-A), FGF21, and fibroblast activation protein (FAP) were compared between the three groups applying the Kruskal-Wallis test. Results: Levels of (IGF-1 µg/L) were not different between the groups (median (25-75 %), untreated KS 162 (140-201.5), treated KS 165 (128.5-215), controls 176.5 (150.8-214.5), p=0.5). Similarly, FGF21 levels (ng/L) were comparable between the groups (median (25-75 %), untreated KS 84.7 (53.3-217.6), treated KS 97.2 (56.4-224.8), controls 100.3 (66.0-191.0), p=0.9). Levels of IGFBP3, PAPP-A and FAP were also found to be comparable between the groups (p≥0.2). Conclusion: This was the first study investigating FGF21 in men with KS. Our results indicate that regulation of the IGF-1 system and levels of FGF21 are not altered in men with KS compared with age-matched controls, and that TT in men with KS does not affect these systems.

Paradoxical effect of testosterone supplementation therapy on cardiac ischemia/reperfusion injury in aged rats

Aging is followed by numerous physiological limitations that reduce health span, particularly cardiovascular and metabolic disorders. Testosterone supplementation therapy (TST) has been widely used in the treatment of aging dysfunctions in either adult or aged patients, although recent evidence have suggested that the incidence of myocardial infarction might be increased in elderly patients. So far, though, the effects of TST in the progression of cardiac ischemia/reperfusion (IR) injury in aged hearts remain unclear. Male aged (23–24 months old) and adult (6 months old) Wistar rats were treated with placebo (Old + Placebo n = 5 / Adult + Placebo n = 5) or TST (Old + TST n = 7 / Adult + TST n = 5) for 30 days. After euthanasia, artificially-perfused isolated rat hearts were submitted to IR. Cardiac expression levels of genes encoding α and β myosin heavy chain (MHC), ryanodine receptor (RyR), brain-natriuretic peptide (BNP), sarcoplasmic reticulum Ca2+ ATPase 2a (SERCA2a), glucose-regulated protein 78 kDa (GRP78), eukaryotic initiation factor 2α (eIF2α), C/EBP-homologous protein (CHOP), caspase 3 and B cell lymphoma 2 (Bcl-2) were accessed by qRT-PCR. Protein levels of CHOP, p-Akt, and p-glycogen synthase kinase 3β (p-GSK-3β) were measured by Western Blot. Compared to placebo-treated aged rats, Old + TST group exhibited increased heart weight and up-regulation of αMHC mRNA expression levels, whereas βMHC mRNA expression (p < 0.05). During reperfusion, left ventricular developed pressure, dP/dt+, dP/dt-, and cardiac contractile function index were increased in Old + TST rat hearts (p < 0.05), whereas infarct size was increased (p < 0.05) in comparison with Old + Placebo group. p-Akt levels of Old + TST rat hearts were decreased when compared to Old + Placebo group. Conversely, TST did not promote significant effects in adult rat hearts. Taken together, these findings suggest that myocardial stunning and infarct size of aged hearts were distinctly affected by TST.

The complex association between metabolic syndrome and male hypogonadism

BackgroundThe complex association between metabolic syndrome (MetS) and male hypogonadism is well established. A number of observational studies show that low testosterone is associated with insulin resistance and an increased risk for diabetes mellitus and MetS in men. AimsTo elucidate the association between MetS and male hypogonadism, present epidemiological data on the co-existence of the two comorbidities, enlighten the underlying pathophysiology and appraise the effects of testosterone supplementation therapy (TTh) and lifestyle modifications on MetS and body composition in men. Materials and MethodsSystematic search to PubMed and Medline databases for publications reporting data on association between MetS and male hypogonadism. ResultsBoth MetS and male hypogonadism have a high prevalence in the general population and are frequently co-existing e.g. in males with diabetes. Accumulating evidence from animal and human studies suggests that MetS is involved in the pathogenesis of hypogonadism in males as well as the other way around. On the other hand, there is evidence for a favorable effect of testosterone supplementation in testosterone deficient men with MetS and/or diabetes mellitus. ConclusionsStudies with superior methodological characteristics are needed in order to establish a role for testosterone supplementation in men with MetS and/or diabetes mellitus.

MP17-09 TESTOSTERONE SUPPLEMENTATION THERAPY DOES NOT INCREASE THE RISK OF PROSTATE CANCER PROGRESSION BUT MIGHT ALTER PATIENT CHOICE FOR DEFINITIVE TREATMENT DURING ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2018MP17-09 TESTOSTERONE SUPPLEMENTATION THERAPY DOES NOT INCREASE THE RISK OF PROSTATE CANCER PROGRESSION BUT MIGHT ALTER PATIENT CHOICE FOR DEFINITIVE TREATMENT DURING ACTIVE SURVEILLANCE Unwanaobong Nseyo, Stephen Unterberg, and Mike Hsieh Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Stephen UnterbergStephen Unterberg More articles by this author , and Mike HsiehMike Hsieh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.564AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The AUA Guidelines on Early Detection of Prostate Cancer provide no specific recommendations for prostate cancer screening among men receiving testosterone supplementation therapy (TST). Data has shown that while TST can cause fluctuations in PSA, it does not confer an increased risk of prostate cancer. As such, concurrent TST in individuals after definitive treatment for prostate cancer is not uncommon. With increasing implementation of active surveillance (AS) protocols, the effect of TST in men with low-risk, untreated prostate cancer warrants more thorough exploration. METHODS A retrospective analysis was performed of a single institution database containing men diagnosed with prostate cancer between 2007-2015. The cohort was further subdivided into those with and without concurrent TST. Comparative analysis was performed on diagnostic characteristics and treatment outcomes between the two groups. Statistical analysis consisted of paired t-test with significance determined by p-value < 0.05. RESULTS A total of 123 men were included in the analysis: 61 of whom were men on TST with a matched group of 62 non-TST men. Thirty-one percent of the entire cohort was on AS (19 men each in the TST and non-TST groups). There were equivalent rates of individuals with a positive family history (15.7% vs 16.7%). Overall, men on TST were diagnosed at lower PSA values (3.1 vs 5.3, p = 0.02), 3 years younger at diagnosis (p = 0.34), and on AS for 36 months longer (p = 0.15) as compared to the non-TST patients. Eleven men demonstrated progression on repeat biopsy during AS (5 in the TST, 6 in the non-TST group). All 5 patients in the TST group and only 1 patient in the non-TST group underwent definitive treatment due to pathologic progression. The remaining non-TST patients with progression chose to continue AS despite recommendations for treatment. CONCLUSIONS Without specific guideline-based recommendations, providers are enrolling men in AS who are concurrently on TST. Men on TST were subjected to a more rigorous protocol, as they were biopsied at younger ages and on AS for a longer period of time; however, prostate cancer detection rates were equivalent in this study. Our data suggests that aggressive screening or treatment is not indicated for men undergoing TST but TST might alter patient choice of definitive therapy during AS protocol. Future studies are needed to further explore the relationship between AS and prostate cancer outcomes for men receiving TST. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e208 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Unwanaobong Nseyo More articles by this author Stephen Unterberg More articles by this author Mike Hsieh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP44-10 THE IMPACT OF THE FDA TESTOSTERONE SUPPLEMENTATION THERAPY SAFETY ADVISORY ON PRESCRIBING PATTERNS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making I1 Apr 2018MP44-10 THE IMPACT OF THE FDA TESTOSTERONE SUPPLEMENTATION THERAPY SAFETY ADVISORY ON PRESCRIBING PATTERNS Valary Raup, Tyler McClintock, Ramy Abou Ghayda, Alexandra Berger, Allen Seftel, and Martin Kathrins Valary RaupValary Raup More articles by this author , Tyler McClintockTyler McClintock More articles by this author , Ramy Abou GhaydaRamy Abou Ghayda More articles by this author , Alexandra BergerAlexandra Berger More articles by this author , Allen SeftelAllen Seftel More articles by this author , and Martin KathrinsMartin Kathrins More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1429AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES On March 3, 2015 the Food and Drug Administration (FDA) released a safety advisory and prescription labeling change which warned of possible cardiovascular side effects of testosterone supplementation therapy (TST). We sought to investigate the effect of the warning on TST prescribing patterns in the Boston metro-area. METHODS We utilized the Research Patient Data Registry, which is a de-identified clinical patient data repository pertaining to eight hospitals in the Boston metro area within Partners Healthcare. We queried the database for men age 45 to 84 years old who were prescribed TST with transdermal or injectable formulations from March 2013 until August 2016. A second query was performed of such patients to quantify the monthly instances in which during which primary diagnosis of hypogonadism was recorded (based on ICD9/10 codes). We three performed separate interrupted time series (ITS) analyses for each TST modality type and monthly visits for hypogonadism, all with respect to the March 2015 safety advisory. We calculated estimates of effect and relative effects for 1, 3, 6, 9, 12, 15, 16 months post-safety advisory. All data analyses were performed with SPSS v20. IRB approval was not necessary due to the de-identified nature of the data. RESULTS The monthly prescription quantities and clinical encounters are demonstrated in Figures 1.1 and 1.2, respectively. The ITS analysis revealed the difference in slope coefficients between pre- and post-safety advisory was -26.5 (p=0.000) for transdermal formulations. The difference in coefficients was -7.5 (p=0.003) for injectable formulations. However, the difference in coefficients for clinical encounters was -3.0 (p=0.260). Limitations of the study were the inability to distinguish between new and renewed prescriptions and the retrospective nature of the database. CONCLUSIONS While the monthly number of interactions resulting in a primary diagnosis of hypogonadism was unchanged, the amount of monthly prescriptions for both injectable and transdermal testosterone formulations decreased significantly following the FDA safety advisory. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e591 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Valary Raup More articles by this author Tyler McClintock More articles by this author Ramy Abou Ghayda More articles by this author Alexandra Berger More articles by this author Allen Seftel More articles by this author Martin Kathrins More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of testosterone supplementation therapy on lipid metabolism in hypogonadal men with T2DM: a meta-analysis of randomized controlled trials.

Testosterone supplementation may be effective for the treatment of hypogonadism in men with type 2 diabetes mellitus (T2DM), but the evidence from randomized controlled trials (RCTs) is inconclusive. We aimed to systematically summarize results from intervention studies and assess the effects of testosterone supplementation therapy (TST) on lipid metabolism in RCTs of hypogonadal men with T2DM by meta-analysis. PubMed, Embase, and Cochrane Library databases were searched for studies reporting the effect of TST on lipid metabolism in hypogonadal men with T2DM until December 31, 2016. Seven RCTs from 252 trials, enrolling a total of 612 patients in the experimental and control groups with a mean age of 58.5years, were included in this study. The pooled results of the meta-analysis demonstrated that TST significantly decreased TC and TG levels in hypogonadal men with T2DM compared with the control group, with mean differences (MDs) of -6.44 (95% CI: -11.82 to -1.06; I2 =28%; p=0.02) and -27.94 (95% CI: -52.33 to -3.54; I2 =76%; p=0.02).Subgroup analyses revealed that the heterogeneity (I2 =76%) of TG originated from different economic regions, in which economic development, genetic and environmental factors, and dietary habits affect lipid metabolism of human, with a decrease (I2 =45%) in developed countries. Additionally, subgroup analyses showed that TST increased HDL-C level in developing countries compared with the control group (MD=2.79; 95% CI: 0.73 to 4.86; I2 =0%; p=0.008), but there was no improvement in developed countries (MD=1.02; 95% CI: -4.55 to 6.60; I2 =91%; p=0.72). However, LDL-C levels were not improved consistently.Because the relationship between lipid metabolism and atherosclerosis is unequivocal, TST, which ameliorates lipid metabolism, may decrease the morbidity and mortality of cardiovascular disease in hypogonadal men with T2DM by preventing atherogenesis.

Testosterone versus clomiphene citrate in managing symptoms of hypogonadism in men

Introduction:Both clomiphene citrate (CC) and testosterone supplementation therapy (TST) are effective treatments for men with hypogonadism. We sought to compare changes in symptoms and treatment efficacy in hypogonadal men before and after receiving CC and TST.Patients and Methods:52 men who received TST and 23 men who received CC for symptomatic hypogonadism were prospectively followed for change in hormone levels and symptoms after treatment. These men were also compared to eugonadal men who were not on CC or TST during the same period. Comparisons were made between baseline and posttreatment hormone levels and symptoms. Symptoms were evaluated using the androgen deficiency in aging male (ADAM) and quantitative ADAM (qADAM) questionnaires.Results:Serum total testosterone increased from pretreatment levels in all men (P < 0.05), regardless of therapy type (TST: 281–541 ng/dL, CC: 235.5–438 ng/dL). Men taking TST reported fewer ADAM symptoms after treatment (5–2, P < 0.05). Similarly, men taking CC reported fewer ADAM symptoms after treatment (3.5–1.5, P < 0.05). Conversely, eugonadal men had similar T levels (352 vs. 364 ng/dL) and hypogonadal symptoms (1.5 vs. 1.4) before and after follow-up. When we evaluated individual symptoms, men treated with TST showed significant increases in qADAM scores in libido, erectile function, and sports performance. However, among the men who received CC, qADAM subscore for libido was lower following treatment (3.75–3.2, P = 0.04), indicating that CC could have an adverse effect on libido in hypogonadal men.Conclusions:Both TST and CC are effective medications in treating hypogonadism; however, our study indicates that TST is more effective in raising serum testosterone levels and improving hypogonadal symptoms. CC remains a viable treatment modality for hypogonadal men but its adverse effect on libido warrant further study.

Novel Uses for the Anabolic Androgenic Steroids Nandrolone and Oxandrolone in the Management of Male Health.

There has recently been renewed interest in novel clinical applications of the anabolic-androgenic steroid (AAS) testosterone and its synthetic derivatives, particularly given with the rising popularity of testosterone supplementation therapy (TST) for the treatment of male hypogonadism. In this manuscript, we provide a brief review of the history of AAS and discuss clinical applications of two of the more well-known AAS: nandrolone and oxandrolone. Both agents exhibit favorable myotrophic/androgenic ratios and have been investigated for effectiveness in numerous disease states. We also provide a brief synopsis of selective androgen receptor modulators (SARMs) and postulate how these orally active, non-aromatizing, tissue-selective agents might be used in contemporary andrology. Currently, the applications of testosterone alternatives in hypogonadism are limited. However, it is tempting to speculate that these agents may oneday become accepted as alternatives, or adjuncts, to the treatment of male hypogonadism.

Dietary Adjuncts for Improving Testosterone Levels in Hypogonadal Males

An increasing number of men are being diagnosed with hypogonadism. While many benefit from testosterone supplementation therapy, others who do not meet the criteria for hormone supplementation have turned to dietary adjuncts as a way or gaining improvements in libido, energy, and physical performance. These oral adjunct medications include controlled substances such as androstenedione, androstenediol as well as other "over-the-counter" options like DHEA (dehydroepiandrosterone) and herbal remedies like Tribulus terrestris This review will focus on the use of these adjunct medications in isolation, or in combination with testosterone supplementation therapy as well as the biochemical nature of the supplements, the results of scientific trials as well as the side effects that limit their use. At the end of this review, physicians will have an improved understanding of the popular testosterone adjuncts being used currently as well as the availability of these substances and how they are used.

033 An Assessment Of The Impact Of Testosterone Supplementation Therapy On Hemoglobin A1C (HbA1C) Levels In Diabetic And Non-Diabetic Men.

033 An Assessment Of The Impact Of Testosterone Supplementation Therapy On Hemoglobin A1C (HbA1C) Levels In Diabetic And Non-Diabetic Men.

Reproductive endocrinology: Oral enclomiphene citrate in obese men with hypogonadism.

Testosterone supplementation therapy is an effective therapy for hypogonadism but can lead to the suppression of spermatogenesis. A new study investigated the effects of enclomiphene citrate, the trans isomer of clomiphene, on serum hormone levels and sperm counts in men with secondary hypogonadism.

Editorial Comment

Ramasamy et al presents a retrospective review of 217 men older than 65 years who had received testosterone supplementation therapy (TST) and compared them to others who are hypogonadal and did not receive therapy. In this small retrospective cohort, testosterone did not appear to increase the risk of thrombotic events in individuals who were on TST. Because of the recent large retrospective trials,1-4 the Food and Drug Administration has revisited the safety and appropriate use of TST. This has led to a great debate within the health care community and with patients themselves.

Association Between Testosterone Supplementation Therapy and Thrombotic Events in Elderly Men

To determine the prevalence of thrombotic events and all-cause mortality in men older than 65 years with hypogonadism treated with testosterone therapy (TST). We retrospectively reviewed the charts of 217 hypogonadal men >65years. We compared men who received TST (n=153) to hypogonadal men (n=64) who did not receive TST. We evaluated all-cause mortality, prevalence of myocardial infarction (MI), transient ischemic attack (TIA), cerebrovascular accident (CVA or "stroke"), and deep vein thrombosis/pulmonary embolism (DVT/PE). All events were verified by contacting patients. We excluded men with previous thrombotic events, men previously on androgen deprivation therapy, and men who had used TST before age of 65years. Median age and Charlson Comorbidity Index of men on TST (74y; 5.1) was similar to hypogonadal men not on TST (73y, P=.48; 5.3, P=.36). Median follow-up was 3.8 vs 3.5years (TST vs no TST). No man on TST died, whereas 5 hypogonadal men who did not receive TST died (P=.007). There were 4 thrombotic events (1 MI, 2 CVA/TIA, and 1 PE) in men who received TST and 1 event (CVA/TIA) among men who did not receive TST (P=.8). All events (1 death, 6-month follow-up) occurred at least after 2years of follow-up. There was increased all-cause mortality in hypogonadal men not treated with testosterone compared to men who received TST. There was no difference in prevalence of MI, TIA/CVA, or PE between patients treated with testosterone and hypogonadal men not treated with testosterone.

MP51-06 INCREASED PREVALENCE OF HYPOPROLACTINEMIA IN MEN TAKING TESTOSTERONE SUPPLEMENTATION THERAPY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation II1 Apr 2015MP51-06 INCREASED PREVALENCE OF HYPOPROLACTINEMIA IN MEN TAKING TESTOSTERONE SUPPLEMENTATION THERAPY Aravind Chandrashekar, Tariq Hakky, Jason Scovell, Ranjith Ramasamy, Alexander Pastuszak, Dolores Lamb, and Larry Lipshultz Aravind ChandrashekarAravind Chandrashekar More articles by this author , Tariq HakkyTariq Hakky More articles by this author , Jason ScovellJason Scovell More articles by this author , Ranjith RamasamyRanjith Ramasamy More articles by this author , Alexander PastuszakAlexander Pastuszak More articles by this author , Dolores LambDolores Lamb More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study is to determine whether or not there was a difference in the prevalence of hypoprolactinemia in patients taking testosterone supplementation therapy (TST) when compared to men not on TST. METHODS We performed a retrospective analysis of men who presented to an academic urology clinic and had available medication usage and prolactin levels. Patients taking cabergoline were excluded from the study. We compared the prevalence of hypoprolactinemia at different cut-points (<1, <3, and <6 ng/ml) using a Pearson Chi-Square test with a significance of p<0.05. RESULTS 4,551 men were included for analysis with a mean age of 45.5 years (Range: 15-96, Std. Dev: 13.197). 49% (n=2242) of men were on TST and 51% (n=2.309) were not. There was a greater prevalence of hypoprolactinemia in men on TST than in men not on TST for prolactin cut-points of <6 ng/mL (40.4% vs. 29.6%, p=0.001) and <3 ng/mL (3.4% vs. 1.8%, p=0.001). There was no statistical difference in the prevalence of profound hypoprolactinemia (<1ng/mL) between men on TST and not on TST (0.4% vs. 0.1%, p=0.074). CONCLUSIONS Prolactin appears to be involved in the central control of sexual function through modulation of dopaminergic and serotoninergic systems. Hypoprolactinemia has also been associated with metabolic syndrome, arteriogenic erectile dysfunction, premature ejaculation, and anxiety. Our study demonstrated that there is a greater prevalence of hypoprolactinemia in men taking testosterone supplementation therapy when compared to men not taking exogenous testosterone. Given this finding, patients on TST may need to be monitored for possible development of signs and symptoms related to low prolactin levels. Table 1. Prevalence of hypoprolactinemia in men on TST and not on TST at different cut-points of serum prolactin. Prolactin No TST % hypoprolactinemia On TST % hypoprolactinemia p-value <1 ng/mL 0.13 0.40 0.074 <3 ng/mL 1.78 3.39 0.001 <6 ng/mL 29.62 40.37 0.001 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e621-e622 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aravind Chandrashekar More articles by this author Tariq Hakky More articles by this author Jason Scovell More articles by this author Ranjith Ramasamy More articles by this author Alexander Pastuszak More articles by this author Dolores Lamb More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...