Treatment Of Late-onset Hypogonadism Research Articles

Treatment of Late-onset Hypogonadism with Traditional Chinese and Western Medicine

Treatment of Late-onset Hypogonadism with Traditional Chinese and Western Medicine

(063) Association between Comorbidities and Longitudinal Changes in Total Testosterone among men from the Baltimore Longitudinal Study of Aging

Abstract Introduction Previous cross-sectional and longitudinal studies have described decreasing testosterone levels with age in men. However, the longitudinal impact of acquired comorbidities in aging males on the relationship between age and testosterone has not been thoroughly investigated. Objective In this longitudinal study, we aimed to evaluate the longitudinal association between age and testosterone levels and to investigate the impact of additive comorbidity burden on this relationship. We hypothesized that when controlling for the presence of comorbidities commonly acquired with age, there would be no association between age and serum total testosterone level. Methods Participants were selected from the Baltimore Longitudinal Study of Aging. Data was obtained on presence of several comorbidities and total testosterone level during each follow-up visit. All men with diagnosis of prostate cancer or documented use of testosterone replacement therapy during their follow-up period were excluded from analysis. A stepwise regression analysis was performed, including a final multivariate panel regression model in order to determine the impact of age on testosterone level while controlling for individual comorbidities. Results A total of 1,784 men were included in this study, with a mean age of 71 years and overall mean testosterone level of 463.2 ng/dL. Participants had an average of 3.23 comorbidities. On multivariable-adjusted panel regression analysis, age was not significantly associated with testosterone decline, while anemia, diabetes mellitus, heart failure, obesity, peripheral artery disease, and stroke were inversely associated with total testosterone level. We report no association between cancer and total testosterone. Conclusions In this large longitudinal study, we found that when adjusted for the presence of concomitant comorbidities, age does not predict a significant decline in testosterone level with age. With the overall increase in life expectancy, and the simultaneous rise in the incidence of comorbidities such as diabetes and dyslipidemia, our findings may help optimize screening and treatment for late-onset hypogonadism in patients with multiple comorbidities. Disclosure No

PD18-08 IMPACT OF COMORBIDITIES ON CHANGES IN SERUM TESTOSTERONE AMONG MEN FROM THE BALTIMORE LONGITUDINAL STUDY OF AGING

You have accessJournal of UrologyCME1 Apr 2023PD18-08 IMPACT OF COMORBIDITIES ON CHANGES IN SERUM TESTOSTERONE AMONG MEN FROM THE BALTIMORE LONGITUDINAL STUDY OF AGING Aaron Gurayah, Chase Carto, Meghan Grewal, Maria Camila Suarez Arbelaez, Taylor Kohn, and Ranjith Ramasamy Aaron GurayahAaron Gurayah More articles by this author , Chase CartoChase Carto More articles by this author , Meghan GrewalMeghan Grewal More articles by this author , Maria Camila Suarez ArbelaezMaria Camila Suarez Arbelaez More articles by this author , Taylor KohnTaylor Kohn More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003273.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have reported that testosterone (T) levels decrease with age in men. However, the role of acquired comorbidities in aging males has been mostly unaccounted for in prior studies investigating this relationship. Thus, we aimed to evaluate the association between age and T levels as well as the impact of having several comorbidities on this association. We hypothesized that age would not be associated with T levels, after accounting for number of patient comorbidities. METHODS: Participants were selected from the Baltimore Longitudinal Study of Aging. Data was obtained on presence of several comorbidities and total testosterone (TT) level during each visit. A univariable and stepwise multivariable panel regression was used to determine the impact of age on TT level while controlling for individual comorbidities. RESULTS: A total of 625 men were included in this study, with a median age of 70±15 years, average follow-up time of 6.7 years, and overall mean TT level of 463±180 ng/dL. In our univariable model, we found several predictors, including age, that were significantly associated with a decline in TT (Table 1). On our multivariable-adjusted model, age was not associated with a decline in TT, while anemia, diabetes mellitus, heart failure, obesity, peripheral artery disease, and stroke were inversely associated with TT levels (Table 1). We found that having 2-4 comorbidities or 5 or more comorbidities was associated with a decline in TT (65 ng/dL and 112 ng/dL, respectively), when compared to those without comorbidities (Table 2). CONCLUSIONS: We report that when adjusted for the presence of concomitant comorbidities, age alone does not predict a significant decline in T level over time. However, a decrease in T levels is likely due to the development of various comorbidities with increasing age. With the overall increase in life expectancy, and the simultaneous rise in the prevalence of comorbidities, our findings may help optimize screening and treatment for late-onset hypogonadism in patients with multiple comorbidities. Source of Funding: This work was supported by NIH Grant R01 DK 130991 and Clinician Scientist Development Grant from the ACS to RR © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e505 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Gurayah More articles by this author Chase Carto More articles by this author Meghan Grewal More articles by this author Maria Camila Suarez Arbelaez More articles by this author Taylor Kohn More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Association between comorbidities and longitudinal changes in total testosterone among men from the Baltimore Longitudinal Study of Aging.

Previous cross-sectional and longitudinal studies have described decreasing testosterone levels with age in men, without consideration of acquired comorbidities in aging males. We evaluated the longitudinal association between age and testosterone levels as well as the impact of several comorbidities on this relationship using multivariate panel regression analysis. Participants were selected from the Baltimore Longitudinal Study of Aging. Data were obtained on the presence of several comorbidities and total testosterone level during each follow-up visit. A multivariate panel regression analysis was performed to determine the impact of age on testosterone level while controlling for individual comorbidities. The primary outcomes were strength of association between age and various comorbidities, and testosterone level. A total of 625 men were included in this study, with a mean age of 65years and a mean testosterone level of 463ng/dL. On multivariable-adjusted panel regression analysis, age was not significantly associated with testosterone decline, while anemia, diabetes mellitus, heart failure, obesity, peripheral artery disease, and stroke were inversely associated with total testosterone level. We report no association between cancer and total testosterone. This study indicates that a decline in testosterone levels over time may be due to the presence of various comorbidities, which affects the medical management of hypogonadism in aging men. The strengths of this study include the standardized acquisition of testosterone tests and uniform collection of variables, while limitations include the lack of follow-up data from 205 patients and the limited racial/ethnic diversity in the cohort. In this large longitudinal study, we found that when adjusted for the presence of concomitant comorbidities, age does not predict a significant decline in testosterone level. With the overall increase in life expectancy and the simultaneous rise in the incidence of comorbidities such as diabetes and dyslipidemia, our findings may help optimize screening and treatment for late-onset hypogonadism in patients with multiple comorbidities.

Clomiphene citrate treatment for late onset hypogonadism: rise and fall.

ABSTRACTObjective:Previous series have demonstrated that Clomiphene Citrate (CC) is an effective treatment to increase Total Testosterone (TT) in Late Onset Hypogonadism (LOH) patients. However, what happens to TT levels after ending CC treatment is still debatable. The objective of this study is to evaluate TT levels 3 months after the discontinuation of CC in patients with LOH who were previously successfully treated with the same drug.Materials and Methods:Twenty-seven patients with LOH that were successfully treated (achieved TT levels >11nmol/l) with CC 50mgs daily for 50 days were prospectively recruited in our Andrological outpatient clinic. CC was then stopped for 3 months and TT levels were measured at the end of this period.Results:Mean TT level before discontinuation of CC was 22.7±8.1nmol/L (mean±SD). Three months after discontinuation, mean TT level significantly decreased in all patients, 10.2±3.9nmol/l (p<0.01). Twenty-one patients (78%) decreased TT levels under 11nmol/L. Six patients (22%) had TT levels that remained within the normal recommended range (≥11nmol/l). No statistical significant differences were observed between both groups.Conclusion:In the short term LOH does not seem to be a reversible condition in most patients after CC treatment. More studies with longer follow-up are needed to evaluate the kinetics of TT in LOH.

P-03-044 Androgen deficiency - induced erectile dysfunction of young male patient with newly diagnosed diabetes mellitus type 2

It is well known that erectile dysfunction is one of the most common complications of diabetes. Up to 75% of men who have diabetes will experience some degree of erectile dysfunction during the lifetime. ED in diabetes has many potential causes, including: diabetic complication as neuropathy and vascular disease, hypertension, use of various medication or psychogenic factors. Prevalence of ED increases with age, with long duration of diabetes and poor glycemic control. This case report describes the case of young male patient with newly diagnosed diabetes mellitus type 2 and erectile dysfunction, with medical history of hypertension and dyslipidemia. Despite achieving ideal glycemic control, treatment of diabetic neuropathy and taking PDE5i inhibitors patient had no improvement of signs of ED. This case shows importance of Testosterone Replacement Therapy in the treatment of late-onset hypogonadism in diabetic patient with ED, even if testosterone level is not severely redused. Patient Information: 33-year-old male patient with newly diagnosed diabetes mellitus type 2. Being under surveillance of cardiologist during 3 years. Past medical history: medical illnesses: hypercholesterolemia 3 yrs, Hypertension 3 yrs. Medication: rosuvastatin 10 mg 3yrs, amlodipine 5 mg 3yrs, valsartan 80 mg 3yrs. physical examination: BMI 29.5, T/A 130/95, p’ – 88’ . Family: 2 children, married. Laboratory results: HbA1c 10%, Hematocrit 45.3, Testosterone <230 (241-827) ng/dl, Cholesterol 122 mg/dl, HDL 37, LDL 63.8, triglycerides 106. PSA - 0.45 ng/dl. Prolactin – in normal ranges. LH - 5.21, FSH – 5.63. Patient was checking blood glucose level twice in a year and 6 month ago his blood glucose was in normal ranges.

Late-onset hypogonadism: etiology, clinical features, diagnostics, treatment

In a critical review of the literature current data concerning etiology, clinical features, diagnostics, treatment of late-onset hypogonadism (LOH) are given. LOH is a multidisciplinary problem, because a patient with LOH can have osteoporosis, anemia, depression, obesity, diabetes mellitus, erectile dysfunction. Sometimes it is hard to realize that all this complaints are symptoms of LOH. LOH has a negative impact on a patient , s quality of life and it , s impossible to help without androgen replacement therapy. Furthermore doctors often have doubts about testosterone replacement therapy safety because of lack of accurate information. In a convenient for medical practitioners form clinical and laboratory diagnostic criteria of LOH are presented together with formulas for conversion from one measurement unit of main sex hormones into another. Based on latest ISSAM guidelines (International Society for the Study of the Aging Male) modern treatment options of LOH are summarized, full information about available testosterone preparations (oral, transdermal, injectable) with comparative analysis of advantages and disadvantages of each is given. A full description of indications and contraindications for androgen replacement treatment is presented, also treatment regimen and medical supervision algorithm during treatment are described.

Alternatives to testosterone replacement: testosterone restoration.

The European Male Aging Study has demonstrated that the hypogonadism of male aging is predominantly secondary. Theoretically with appropriate stimulation from the pituitary, the aging testis should be able to produce eugonadal levels of testosterone. The strategies for the treatment of late onset hypogonadism (LOH) have focused on replacement with exogenous testosterone versus restoration of endogenous production. The purpose of this article is to review existing peer-reviewed literature supporting the concept of restoration of endogenous testosterone in the treatment of LOH.

Re: The treatment of late-onset hypogonadism

Hypogonadism has clearly been shown to influence sexual and multi-system function.[1–3] In this article,[4] the authors reviewed the negative effects of late-onset hypogonadism (LOH) on different systems and gave details on treatment of it. LOH that is defined by reduced serum testosterone levels associated with clinical symptoms at middle ages mainly seen after 40 years old. Testosterone, formerly known associated with sexual function, goes far beyond sexual function and is now considered a hormone with numerous effects on male physiology, in particular regarding metabolic functions. It is well documented that testicular testosterone production decreases in men with ageing, by 1–2% per year.[5] However, on average serum levels of testosterone still remain within the normal range of young men. “Who should be offered testosterone replacement?”. There is still no general consensus on the threshold of circulating testosterone below which replacement therapy is recommended. The panelists for the Endocrine Society guideline failed to reach a consensus regarding the testosterone threshold for older men, as some of them favored a threshold of 9.7–10.4 nmol/L; whereas, others felt that a threshold of 6.9 nmol/L was more appropriate.[6] In case of dilemma, questionnaires like Aging Males’ Symptoms Questionnaire (AMS-Q), which has validated Turkish version, can be helpful. Evidences support the concept that testosterone is an anabolic hormone with a wide range of beneficial effects on men’s health. The therapeutic role of testosterone in men’s health, however, remains a hotly debated issue for a number of reasons, including the purported risk of prostate cancer. As urologists, we always asked a critical question “Is there any existing relation between testosterone and the development of prostate pathology (prostate cancer and/or hyperplasia)?”. The answer was given in a very recent review of current literature[7] regarding the relationship of serum testosterone on prostate cancer. The results dispelled the historical fear that raising testosterone levels will result in more prostate cancer. Studies have failed to show increased risk of prostate cancer in men with higher serum testosterone, and supraphysiological testosterone fails to increase prostate volume or prostate specific antigen in healthy men. This apparent paradox is explained by the “saturation model,” which posits a finite capacity of androgen to stimulate growth of prostate cancer. Modern studies indicate no increased risk of prostate cancer among men with serum testosterone in the therapeutic range.[7] In conclusion, testosterone is not a “niche” hormone, but a multi system hormone with much wider range of actions than reproduction or sexual functions. Early recognition and treatment of patients with LOH might help reduce the likelihood that these aforementioned[4] clinical features progress.

Clinical diagnosis and treatment of late-onset hypogonadism

Testosterone is the principal androgen in the human male. The decline of testosterone with aging was recognized to be associated with a number of symptoms and signs that reduce the quality of life and that may even have severe, debilitating consequences. So testosterone deficiency in the aging male has become a topic of increasing interest and debate throughout the world. Clinically, late-onset hypogonadism (LOH) is diagnosed by the presence of symptoms or signs and persistent low serum testosterone levels. The benefits and risks of testosterone therapy must be clearly discussed with the patient and assessment of prostate and other risk factors considered before commencing testosterone treatment. Response to testosterone treatment should be assessed. It there is no improvement of symptoms and signs, treatment should be withdrawn and the patient investigated for other possible causes of the clinical presentations. Overall, the problem of LOH in debilitating the quality of life and well-being is real, and by following proper guidelines with attentiveness to the results of treatment trials, testosterone replacement therapy presents a safe and effective treatment option.

Treatment for late-onset hypogonadism: the current situation in Japan

Prevention of age-related disability has become very important because the number of people aged 60 years and older is increasing rapidly. Androgen levels decrease with aging and this plays many physiologic roles in various organs. Late-onset hypogonadism (LOH) has received widespread attention in the last few years. LOH symptoms include sexual dysfunction and depression, and the first-line treatment should be hormone replacement therapy (HRT), by which several symptoms of LOH are improved. Although several types of testosterone preparations are available worldwide, the testosterone preparations available in Japan are limited. For this reason, the Clinical Practice Manual for LOH, authored by a collaborative team from the Japanese Urological Association and the Japanese Society for the Study of the Aging Male, recommends HRT with testosterone enanthate, human chorionic gonadotropin (hCG) and ‘Glowmin’, a short-acting testosterone ointment produced in Japan. In this review, we summarize the efficacy of HRT for LOH symptoms and introduce hCG and Glowmin therapy according to the Clinical Practice Manual. However, several studies, including our own, have shown that LOH symptoms are not always related to serum testosterone concentration. Thus, HRT is not adequate as the only treatment option for LOH because eugonadal men with symptoms of LOH comprise 30% of the general population. We discuss the efficacy of Japanese herbal medicines, which have been used for treatment of the menopause and several psychological disorders, particularly in the treatment of eugonadal patients with symptoms of LOH.

Hormone replacement Up-to-date. Clinical practice of androgen replacement therapy

Androgen replacement therapy (ART) should be considered for initial treatment of late-onset hypogonadism. Intramuscular injection of testosterone enanthate is frequently used for ART in Japan. Prior to ART, it is necessary to measure prostate specific antigen (PSA) in order to rule out prostate cancer, and hematological examination should be performed periodically during treatment to monitor for polycythemia.

Clinical experience with Andriol® Testocaps®– The first Austrian surveillance study on the treatment of late-onset hypogonadism

Objective. The objective of this study was to document the efficacy and tolerability of the new formulation of Andriol® Testocaps® in the treatment of late-onset hypogonadism in a clinical practice setting.Methods. The primary inclusion criterion was symptomatic testosterone deficiency, as confirmed by laboratory testing (morning total testosterone <12 nmol/L) on two separate occasions. The study was performed in 43 centres in Austria and a dosage of oral testosterone undecanoate of 2×80 mg/day was used for three months. The ADAM questionnaire, the AMS scale and the SF-36 questionnaire were administered by the patients and specific questions were asked to the prescribers.Results. A total of 189 patient report forms and 185 doctor report forms were completed. The average age of the participants was 54.7 ± 12.3 years and average treatment duration was 13.9 ± 2.2 weeks. Serum testosterone level increased by more than 50% from 8.7 ± 4.3 nmol/L to 13.2 ± 6.7 nmol/L (p < 0.001). Treatment improved symptoms on the ADAM and AMS scales, whereas no changes were observed on the SF-36. There were no significant effects on serum PSA levels.Conclusion. Short-term treatment with oral testosterone undecanoate in a clinical practice setting improved late-onset hypogonadism symptoms in aging men with low testosterone levels.