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Testosterone Therapy (testosterone + therapy)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Testosterone Therapy and Obstructive Sleep Apnea: Is There a Real Connection?

THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2007
Han 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]

Review article Testosterone therapy in the ageing male: what about the prostate?

ANDROLOGIA, Issue 6 2004
D. Schultheiss
Summary. The concerns about testosterone therapy in ageing men with late-onset hypogonadism mainly address the risk of prostatic disease, i.e. either benign prostatic hyperplasia (BPH) or prostate cancer (PCa). Both conditions are highly dependent on androgen action and recent clinical data on the cancer-preventive effect of the 5, -reductase inhibitor finasteride have supported the possible role of androgens in PCa. However, the clinical data especially on the long-term effects of exogenous androgen substitution in regard to prostate safety are nonconclusive in many respects. As sufficient clinical studies on these risks will not be available in the near future, the approach of testosterone therapy towards prostate complications should be kept on a safe but practical basis. This review includes some recommendations in regard to testosterone therapy and prostate monitoring in patients with BPH and bladder outlet obstruction, with previous history of curative treatment for PCa or with prostatic intraepithelial neoplasia. [source]

StriantÔ SR: a novel, effective and convenient testosterone therapy for male hypogonadism

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2004
M. Korbonits
Summary StriantÔ SR (marketed as Striant® in the US) is a novel sustained-release mucoadhesive buccal testosterone tablet for the treatment of male hypogonadism. StriantÔ SR restores serum testosterone concentrations to the physiological range within 4 h of application, and steady-state concentrations are achieved within 24 h of twice-daily dosing. In phase III clinical trials, 87,97% of patients using StriantÔ SR achieved 24-h-averaged serum testosterone concentrations within the normal range. In a comparative study, StriantÔ SR was more likely to restore testosterone concentrations to the physiological range than Andropatch®. In a small study, StriantÔ SR produced steady-state testosterone concentrations comparable with those achieved with a testosterone gel (50 mg testosterone). StriantÔ SR was well tolerated, with a low incidence of adverse events and a low discontinuation rate (3.5%) due to adverse events in phase III studies. StriantÔ SR is an effective, well-tolerated, convenient and discreet treatment for male hypogonadism. [source]

Recent trends in the treatment of testosterone deficiency syndrome

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2007
Bum Sik Hong
Abstract: Testosterone deficiency syndrome (TDS) is defined as a clinical and biochemical syndrome associated with advancing age and is characterized by typical symptoms and deficiency in serum testosterone levels. TDS is a result of the interaction of hypothalamo-pituitary and testicular factors. Now, treatment of TDS with testosterone is still controversial due to a lack of large, controlled clinical trials on efficacy. The risks of treatment with testosterone appear to be minimal, although long-term studies on the safety of testosterone therapy are lacking. The aim of the therapy is to establish a physiological concentration of serum testosterone in order to correct the androgen deficiency, relieve its symptoms and prevent long-term sequelae. All of the available products, despite their varying pharmacodynamic and pharmacokinetic profiles, are able to reach this goal. Newer testosterone patches seem not to cause severe skin irritation. Testosterone gels minimize the skin irritation while providing flexibility in dosing and a low discontinuation rate. Oral testosterone undecanoate (TU) is free of liver toxicity. Recent formulation of oral TU markedly increased shelf-live, a major drawback in the older preparation. Producing swings in testosterone levels rising rapidly to the supraphysiological range is not the case with the new injectable long-acting preparation of TU. To be able to rapidly react and stop treatment in cases where side-effects and contraindications are detected, the short-acting transdermal and oral delivery modes have certain advantages. However, there is no evidence that the use of an injectable long-acting TU in men with TDS has limitations in clinical application for this reason. The use of dehydroepiandrosterone is still controversial because of a lack of well designed long-term trials, although some recent studies suggest positive effects on various body systems. Only a few studies have been carried out to investigate the effect of hCG (human chorionic gonadotropin) in TDS with some positive results on various body systems. [source]

ORIGINAL RESEARCH,EPIDEMIOLOGY: The Incidence of Invasive Breast Cancer Among Women Prescribed Testosterone for Low Libido

THE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009
Susan R. Davis MD
ABSTRACT Introduction., Although the efficacy of testosterone for the treatment of hypoactive sexual desire disorder is well established, the effect of testosterone therapy on breast cancer risk remains uncertain. Aim., The incidence of invasive breast cancer among past and current testosterone users. Methods., Retrospective cohort study of 631 women ever treated with testosterone between January 1989 and December 2007 in a clinical endocrinology practice. Main Outcome Measure., The incidence of invasive breast cancer since first exposure, and the standardized incidence rate ratio (IRR) calculated using Australian age-specific incidence rates for 2005. Results., The mean age of the women at first exposure to testosterone therapy was 49.1 ± 8.2 years, median treatment duration, 1.3 years, and mean follow-up of 6.7 ± 4.6 years, providing 4,015 woman-years of follow-up. Twelve cases of invasive breast cancer occurred among 599 women breast cancer-free before treatment, giving an age adjusted IRR of 1.35 (95% confidence interval 0.76,2.38). There was no evidence of an independent effect of duration of exposure on breast cancer risk. Conclusion., In this study, testosterone use was not associated with a significant increase in breast cancer risk. Davis SR, Wolfe R, Farrugia H, Ferdinand A, and Bell RJ. The incidence of invasive breast cancer among women prescribed testosterone for low libido. J Sex Med 2009;6:1850,1856. [source]

CHARGE syndrome as unusual cause of hypogonadism: endocrine and molecular evaluation

ANDROLOGIA, Issue 5 2010
L. Foppiani
Summary Coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, ear anomalies (CHARGE) syndrome is a genetic syndrome in which hypogonadism is a frequent feature. A causative mutation within the chromodomain helicase DNA-binding protein-7 gene, which plays an important role in the embryonic development, is present in 2/3 of affected patients. We describe the clinical, hormonal and molecular characteristics of a young man from Ecuador who was diagnosed as having CHARGE syndrome at an adult age. The patient showed several phenotypic features of the syndrome, associated with a prepubertal state and cryptorchidism; hypogonadotrophic hypogonadism with undetectable testosterone levels not responsive to hCG testing and severe osteoporosis were ascertained. Molecular evaluation of the CHD7 gene showed the novel frameshift truncating heterozygous mutation p.Tyr1046Glyfs*23 in exon 12. Magnetic resonance imaging revealed mild hypoplasia of the pituitary gland and hypoplasia of the posterior cranial fossa. Parenteral testosterone therapy led to sexual development over time and, in combination with diphophonate therapy and calcium,vitamin D supplementation, significantly improved bone mineralisation. Early proper hormonal treatment of hypogonadism in patients with complex genetic syndromes is important to achieve normal sexual maturation, improve quality of life and avoid significant comorbidities, such as osteoporosis. [source]

Review article Testosterone therapy in the ageing male: what about the prostate?

Serum sex hormones and the 20-year risk of lower urinary tract symptoms in community-dwelling older men

BJU INTERNATIONAL, Issue 11 2010
Michael D. Trifiro
Study Type , Prognosis (inception cohort) Level of Evidence 2b OBJECTIVE To evaluate serum sex steroid hormone concentrations and long-term risk of subsequent lower urinary tract symptoms (LUTS) in a cohort of community-dwelling older men. SUBJECTS AND METHODS Between 1984 and 1987, serum sex hormone concentrations were measured in participants in the Rancho Bernardo Study, a prospective, community-based study. In 2006, the American Urological Association Symptom Index (AUA-SI) was mailed to surviving male participants. Logistic regression was used to examine associations of baseline hormone concentrations with AUA-SI. RESULTS Among 158 surviving men with complete data and no history of prostate cancer, the mean (sd) age at serum sex steroid assessment was 58 (6.6) years with a mean (sd) follow-up of 20.3 (0.6) years. In age-adjusted logistic regression, there was a significant inverse association of testosterone : dihydrotestosterone (DHT) with LUTS (P = 0.05). Also, men with higher concentrations of bioavailable testosterone had a 56% decreased risk of LUTS compared with those with hypogonadal concentrations, although the association was not statistically significant (odds ratios 0.44, 95% confidence interval 0.14,1.40) or distributed evenly among quartiles. There were no significant associations of total testosterone, oestradiol (E2), testosterone : E2, DHT, or dehydroepiandrosterone with LUTS or with any measured hormones and urinary bother. CONCLUSIONS In this cohort, men with higher mid-life levels of testosterone : DHT and bioavailable testosterone had a decreased 20-year risk of LUTS. These data support other studies reporting inverse associations of serum testosterone with LUTS. Clinical trials of testosterone therapy should include LUTS and clinical benign prostatic hyperplasia as outcomes. [source]

Serum testosterone and bioavailable testosterone correlate with age and body size in hypogonadal men treated with testosterone undecanoate (1000 mg IM , Nebido®)

CLINICAL ENDOCRINOLOGY, Issue 4 2008
Robert Moisey
Summary Objective, To investigate the loading regimen for intramuscular (IM) testosterone undecanoate (Nebido®) to determine whether testosterone and bioavailable testosterone levels achieved correlate with age or body size of subjects studied. Design, Retrospective observational study of testosterone naïve patients and patients previously treated with an alternative testosterone therapy. Patients, 51 hypogonadal men (35, 68·6% secondary hypogonadism). 8 (16%) had not previously received testosterone therapy. Measurements, Patients received an IM injection of Nebido (1000 mg) at baseline and a second injection after 6 weeks. Serum was assayed at baseline and 18 weeks after commencing Nebido for total testosterone (TT) and SHBG. Bioavailable testosterone was calculated (cBioT) using TT and SHBG. Measurements were taken for weight, body mass index (BMI) and body surface area (BSA). Results, Baseline TT (mean 11·5 nmol/l, range 0·3,54·8) increased by 50% after commencing Nebido (17·2 nmol/l (5·4,32·8), P = 0·0001). 75% of subjects had a TT within the reference range (8·0,25·0 nmol/l). Subjects with primary hypogonadism had a higher 18-week TT [20·9 nmol/l (9·8,32·8) vs. 15·5 (5·4,32·6), P = 0·02] and SHBG [39·2 nmol/l (11,82) vs. 25·7 (9·0,60·0), P = 0·003] although the cBioT was not significantly different [4·9 nmol/l (2·9,7·3) vs. 4·2 (2·0,7·9), P = 0·12]. The 18-week TT positively correlated with age (R = 0·36, P = 0·01) and negatively correlated with weight (R = ,0·38, P = 0·006), BMI (R = ,0·42, P = 0·002) and BSA (R =,0·38, P = 0·007). Similarly cBioT correlated with age (R = 0·28, P = 0·04), weight (R = ,0·29, P = 0·03), BMI (R = ,0·30, P = 0·03) and BSA (R = ,0·27, P = 0·05). Age (t = 2·04, P = 0·05) and baseline testosterone (t = ,9·26, P < 0·0001) were independent variables of the increase in TT at 18 weeks. Conclusion, This starting regimen is simple and provides the majority of men with a TT within the reference range. Age and baseline TT are independent variables of the increase in TT with IM testosterone undecanoate. At week 18 age and body size correlated with the cBioT and TT and this may then be used to estimate dosing frequency for this therapy. [source]

Reversal of polycythaemia induced by intramuscular androgen replacement using transdermal testosterone therapy

CLINICAL ENDOCRINOLOGY, Issue 1 2004
H. Siddique
No abstract is available for this article. [source]