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Testosterone Replacement Therapy (testosterone + replacement_therapy)
Selected AbstractsThe aging male , diagnosis and therapy of late-onset hypogonadismJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 4 2008Gerhard Schreiber Summary Managing the clinical features of hormone insufficiency in aging men is an important field of activity for dermatologists and in particular for dermatologists specialized in andrology. Potential consequences of age-associated decrease in plasma testosterone levels include long-term changes in diverse organ systems including changes of bone architecture, body composition, muscular strength, cognitive functions, and mood as well as negative effects on skin and hair. Indications and contraindications for a hormone replacement therapy as well as therapy monitoring are well-defined. Replacement of testosterone in the case of late-onset hypogonadism is not a standardized therapy. Previous studies suggest that testosterone replacement therapy has positive clinical effects. Dermatologic effects of testosterone replacement therapy have not yet been investigated. Further research is required to identify potential benefits and risks of hormone replacement therapy in aging men. [source] Hypogonadism in men with type 2 diabetesPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 5 2007TH Jones BSc Abstract Recent studies demonstrate a high prevalence of hypogonadism in men with metabolic syndrome and type 2 diabetes. Men with low testosterone levels have a higher mortality rate. Diagnosis and treatment with testosterone replacement can lead to improvement in well-being and quality of life. Early studies of testosterone replacement therapy have shown a benefit on glycaemic control, insulin resistance, visceral adiposity and cholesterol. Low testosterone levels are associated with the presence and the degree of atherosclerosis in carotid, coronary and aortic vessels. Furthermore, testosterone replacement therapy in testosterone deficient men with erectile dysfunction converts over half of PDE5 inhibitor non-responders to responders. This review presents the up-to-date evidence in relation to testosterone, and discusses the importance of criteria to make a diagnosis of hypogonadism in diabetic men. Copyright © 2007 John Wiley & Sons. [source] Testosterone Therapy and Obstructive Sleep Apnea: Is There a Real Connection?THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2007Han M. Hanafy MD ABSTRACT Introduction., With the recent increased recognition and treatment of hypogonadism in men, a caution has been given that testosterone replacement therapy (TRT) may cause or aggravate obstructive sleep apnea syndrome (OSA). Aim., To evaluate the scientific data behind the cautionary statements about TRT and OSA. Main Outcome Measures., Methodology and criteria for such studies and evaluation of documents and results based on methodology, duration, and outcome of treatment. Methods., A review of the literature on the subject of TRT and OSA was performed. The possible mechanisms of action of TRT, on breathing and respiration during sleep were explored. Result., Historically, the first such caution came in 1978. Since then, a few similar incidence reports have been cited. The total number of patients in such reports was very small, very disproportional to the millions of patients treated with TRT. Also, there was a lack of consistent findings connecting TRT to OSA. In addition, different results may occur with physiologic replacement vs. supraphysiologic doses in regard to breathing and OSA. The studies showing the effect of TRT on OSA and breathing were all case studies with small numbers of subjects and showed little effect of TRT on OSA in the majority of case reports. Only one study using supraphysiologic doses was a double-blind, placebo-controlled study, which showed a development of OSA in healthy pooled subjects. The other reports were case studies with limited numbers of subjects, suggesting an inconsistent effect of supraphysiologic TRT on OSA and breathing. Conclusion., Cautionary statements about TRT in OSA appear frequently in the TRT literature and guidelines, despite lack of convincing evidence that TRT causes and/or aggravates OSA. Also, there is a lack of consistency in the findings connecting TRT to OSA. It is evident that the link between TRT and OSA is weak, based on methodological issues in many of the studies, and most studies involved small numbers of men. Further studies in this area are needed. Hanafy HM. Testosterone therapy and obstructive sleep apnea: Is there a real connection? J Sex Med 2007;4;1241,1246. [source] Prostatic Specific Antigen in Patients with Hypogonadism: Effect of Testosterone ReplacementTHE JOURNAL OF SEXUAL MEDICINE, Issue 2 2005Ahmed I. El-Sakka MD ABSTRACT Introduction., The effect of parenteral testosterone replacement therapy on prostatic specific antigen (PSA) level or the development or growth of prostate cancer is unclear. Aim., To assess the effect of testosterone replacement on PSA level in patients with hypogonadism associated with erectile dysfunction (ED). Methods., A total of 187 male patients above the age of 45 with hypogonadism associated with ED were enrolled in this study. Patients were screened for ED by the erectile function domain of the International Index of Erectile Function (IIEF). Patients underwent routine laboratory investigations, plus total testosterone, and PSA assessment. Replacement treatment with parenteral testosterone every 2,4 weeks for 1 year was instituted. Total testosterone and PSA serum levels were assessed every 3 months during the treatment course. Results., Mean age ± SD was 62.8 ± 11.4. Of the patients 87.7% were sexually active. Of the patients 10.2% had mild, 40.6% had moderate and 49.2% had severe ED. Of the study population, 62.5% had ED complaints for less than 5 years and 84.5% had gradual onset of their complaint. The majority of the patients (91.4%) had either progressive or stationary course while the minority reported regressive course and improvement of the condition. There was a significant increase of the post-treatment testosterone level in comparison to pretreatment level (P < 0.05). No significant increase in the post-treatment PSA level in comparison to pretreatment (P > 0.05). No significant difference between pre- and post-treatment categories of PSA level (normal, borderline, high) in relation to the severity of ED (P > 0.05). There was no significant association between PSA level and the duration of testosterone replacement therapy in the study population (P > 0.05). Conclusion., The current study demonstrated that the level of PSA was not significantly changed after 1 year of testosterone replacement therapy in patients with hypogonadism associated with ED. [source] Randomized cross-over clinical trial of injectable vs. implantable depot testosterone for maintenance of testosterone replacement therapy in androgen deficient menCLINICAL ENDOCRINOLOGY, Issue 1 2010Carolyn Fennell Summary Background, Life-long testosterone replacement therapy (TRT) for younger men with organic androgen deficiency is best provided by depot testosterone (T) products. This study compared directly the two long-acting depot T products, subdermal T implants (TI) and injectable T undecanoate (TU) for maintenance of TRT. Design, setting and participants, Men with organic androgen deficiency (n = 38) undergoing regular TRT at an academic Andrology centre were recruited for a two period, randomized sequence, cross-over clinical trial without intervening wash-out period of TRT maintenance. Outcomes, For both depot T products, their pharmacokinetics and pharmacodynamics were evaluated using a range of androgen sensitive clinical, laboratory and quality of life measures as well as preference for ongoing treatment after experience of both products. Results, The two depot T products had distinct pharmacokinetics and were not bioequivalent. However, there were no consistent clinical differences in a comprehensive range of pharmacodynamic measures reflecting androgen effects on biochemistry and haematology, muscle mass and strength, and quality of life, mood and sexual function. The majority (91%) of participants chose TU over TI at study completion. Conclusion, Despite significant pharmacokinetic differences, the two depot T products are clinically interchangeable allowing for choice dependent on patient and physician delivery preference in practice but most patients preferred the injectable over the implantable form. [source] ,What should I do with a 60-year old man with a slightly low serum total testosterone concentration and normal levels of serum gonadotrophins'?CLINICAL ENDOCRINOLOGY, Issue 5 2010T. Hugh Jones Summary The fundamental question in assessing an older man with a slightly low total testosterone and normal gonadotrophin levels is to determine whether or not he has clinical hypogonadism. Hypogonadism is defined as a clinical syndrome complex, which comprises both symptoms as well as biochemical testosterone deficiency. As symptoms are nonspecific and there are no clear cut-off values for testosterone levels this invariably leads to a clinical dilemma. International guidelines have been published which provide recommendations to aid the clinician in making a diagnosis. Late-onset hypogonadism, the preferred terminology for age-related hypogonadism, can only be made once other causes have been excluded. Evidence shows that low testosterone levels are associated with several common male conditions including erectile dysfunction, osteoporosis and diabetes. Short-term studies have shown benefits of testosterone replacement therapy (TRT) on body composition, bone metabolism, insulin resistance, sexual function and quality of life. Recommendations give clear advice on safety monitoring, specifically in relation to prostate health. If a diagnosis of hypogonadism is made with borderline testosterone levels then a 3-month trial of TRT can be considered. The diagnosis of hypogonadism associated with borderline testosterone levels and the decision to treat should only be made by an experienced clinician. [source] Androgens, insulin resistance and vascular disease in menCLINICAL ENDOCRINOLOGY, Issue 3 2005D. Kapoor Summary Type 2 diabetes mellitus is increasing globally and is an established risk factor for the development of atherosclerotic vascular disease. Insulin resistance is the hallmark feature of type 2 diabetes and is also an important component of the metabolic syndrome. There is evidence to suggest that testosterone is an important regulator of insulin sensitivity in men. Observational studies have shown that testosterone levels are low in men with diabetes, visceral obesity (which is strongly associated with insulin resistance), coronary artery disease and metabolic syndrome. Short-term interventional studies have also demonstrated that testosterone replacement therapy produces an improvement in insulin sensitivity in men. Thus hypotestosteronaemia may have a role in the pathogenesis of insulin-resistant states and androgen replacement therapy could be a potential treatment that could be offered for improvements in glycaemic control and reduction in cardiovascular risk, particularly in diabetic men. [source] | ||||||||||