Hypogonadism in men with diabetes: Should testosterone replacement therapy be based on evidence based testosterone levels and lifetime risk reduction?

2020 ◽  
Keyword(s):  
Replacement Therapy ◽  
Risk Reduction ◽  
Lifetime Risk ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Evidence Based ◽  
Testosterone Levels

Correction of Androgen Deficiency in Men with Type 2 Diabetes

2021 ◽  
Vol 16 ◽  
Author(s):  
Volodymyr Pankiv ◽  
Tetyana Yuzvenko ◽  
Nazarii Kobyliak ◽  
Ivan Pankiv
Keyword(s):  
Type 2 Diabetes ◽  
Replacement Therapy ◽  
Testosterone Replacement ◽  
Control Group ◽  
Total Testosterone ◽  
Testosterone Replacement Therapy ◽  
Androgen Deficiency ◽  
Testosterone Undecanoate ◽  
Testosterone Levels

Background: In men with low levels of testosterone in the blood, it is believed that the symptoms can be regarded as an association between testosterone deficiency syndrome and related comorbidities. Aim: to investigate the effectiveness of testosterone therapy in patients with type 2 diabetes (T2D) and androgen deficiency. Materials and methods: Testosterone replacement therapy was carried out in 26 men with T2D and clinically or laboratory-confirmed androgen deficiency. The age of the subjects ranged from 35 to 69 years old. Laboratory studies included determinations of the concentration of the hormones estradiol, luteinizing hormone (LH), and prostate-specific antigen (PSA). The observation period was 9 months. Results: The average level of total blood testosterone in the subjects before treatment was 9.4 mol/l and was likely lower than that of the control group (19.3 ± 1.6 nmol/l). The levels of total testosterone in the subjects ranged from 3.9 nmol/l to 10.7 nmol/l, and hormone levels measuring less than 8.0 nmol/l were observed in only 11 patients. After a course of testosterone replacement therapy, a stabilization in total testosterone levels at the level of reference values (as compared to the start of treatment) was observed in the blood of men with T2D after 9 months of observation and the administration of the fourth injection (16.83 ± 0.75 nmol/l). Conclusion: The use of long-acting injectable testosterone undecanoate leads to normalization of total testosterone levels in the blood of men with T2D and androgen deficiency, and LH levels in these patients are unlikely to change.

scholarly journals The Effect of Testosterone Replacement Therapy on Penile Hemodynamics in Hypogonadal Men With Erectile Dysfunction, Having Veno-Occlusive Dysfunction

2018 ◽  
Vol 12 (3) ◽  
pp. 634-638 ◽  
Author(s):  
Ozan Efesoy ◽  
Selahittin Çayan ◽  
Erdem Akbay
Keyword(s):  
Erectile Dysfunction ◽  
Replacement Therapy ◽  
Erectile Function ◽  
Peak Systolic Velocity ◽  
Resistive Index ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Testosterone Levels ◽  
Diastolic Velocity ◽  
Physiological Serum

Hypogonadism may cause veno-occlusive dysfunction (VOD) by structural and biochemical alterations in the cavernosal tissue. The aim of the study was to investigate the effect of testosterone replacement therapy (TRT) on penile hemodynamics in hypogonadal men with erectile dysfunction and VOD. The study included 32 hypogonadal men with erectile dysfunction, having VOD. All patients underwent penile color Doppler ultrasonography (PCDU) at the beginning and 6 months after the initial evaluation. Erectile function was evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5); hypogonadism was evaluated by testosterone measurement and the Aging Male Symptoms (AMS) scale. All patients received transdermal testosterone 50 mg/day for 6 months. Clinical and radiological findings were compared before and 6 months after the TRT. The mean age was 58.81 ± 4.56 (52–69) years. Mean total testosterone levels were 181.06 ± 39.84 ng/dL and 509.00 ± 105.57 ng/dL before and after the therapy, respectively ( p < .001). While all patients had physiological serum testosterone levels (>320 ng/dL) after the therapy, three cases (9.3%) had no clinical improvement of hypogonadism symptoms. Cavernosal artery peak systolic velocity (PSV) and resistive index (RI) significantly increased, and end diastolic velocity (EDV) significantly decreased after TRT. VOD no longer existed in 21 (65.6%) of the cases. This study demonstrated that TRT may restore penile hemodynamics in hypogonadal men with VOD.

Cardiovascular and Cerebrovascular Safety of Testosterone Replacement Therapy Among Aging Men with Low Testosterone Levels: A Cohort Study

2019 ◽  
Vol 132 (9) ◽  
pp. 1069-1077.e4 ◽  
Author(s):  
Simone Y. Loo ◽  
Laurent Azoulay ◽  
Rui Nie ◽  
Sophie Dell’Aniello ◽  
Oriana Hoi Yun Yu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Replacement Therapy ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Testosterone Levels ◽  
Aging Men ◽  
Low Testosterone

scholarly journals Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy

2020 ◽  
Vol 22 (1) ◽  
pp. 21
Author(s):  
Veerle Ide ◽  
Dirk Vanderschueren ◽  
Leen Antonio
Keyword(s):  
Replacement Therapy ◽  
Clomiphene Citrate ◽  
Serum Testosterone ◽  
Good Alternative ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Safe Alternative ◽  
Testosterone Levels ◽  
Sexual Symptoms ◽  
Near Future

Central hypogonadism is a clinical condition, characterized by sexual symptoms and low serum testosterone levels, due to an impaired function of the hypothalamus or pituitary gland. Testosterone replacement therapy (TRT) is the standard treatment for hypogonadism, but it has some disadvantages. TRT is not a good option in men wishing to preserve fertility, nor in men with (a high risk of) prostate cancer, polycythemia, thrombophilia and severe cardiovascular disease. In this review, we discuss alternative treatments for central hypogonadism. If reversible causes are present, non-pharmacological interventions can be therapeutic. Gonadotropins are a good alternative to TRT when fertility is desired in the near future though they require frequent injections. Clomiphene citrate and tamoxifen seem to be a safe alternative for the treatment of functional central hypogonadism in men, as several studies reported a significant increase in testosterone levels with these drugs. However, their use is off-label and data supporting the efficacy of clomiphene citrate and tamoxifen on hypogonadal symptoms are insufficient. For this reason, clomiphene citrate and tamoxifen should not be used in routine clinical practice to treat sexual symptoms in men with central hypogonadism.

scholarly journals Hypogonadism in the Aging Male Diagnosis, Potential Benefits, and Risks of Testosterone Replacement Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-20 ◽  
Author(s):  
Prasanth N. Surampudi ◽  
Christina Wang ◽  
Ronald Swerdloff
Keyword(s):  
Replacement Therapy ◽  
Serum Testosterone ◽  
Diagnostic Methods ◽  
Testosterone Replacement ◽  
Controlled Study ◽  
Testosterone Replacement Therapy ◽  
Testosterone Therapy ◽  
Testosterone Levels ◽  
Aging Men ◽  
Potential Benefits

Hypogonadism in older men is a syndrome characterized by low serum testosterone levels and clinical symptoms often seen in hypogonadal men of younger age. These symptoms include decreased libido, erectile dysfunction, decreased vitality, decreased muscle mass, increased adiposity, depressed mood, osteopenia, and osteoporosis. Hypogonadism is a common disorder in aging men with a significant percentage of men over 60 years of age having serum testosterone levels below the lower limits of young male adults. There are a variety of testosterone formulations available for treatment of hypogonadism. Data from many small studies indicate that testosterone therapy offers several potential benefits to older hypogonadal men. A large multicenter NIH supported double blind, placebo controlled study is ongoing, and this study should greatly enhance the information available on efficacy and side effects of treatment. While safety data is available across many age groups, there are still unresolved concerns associated with testosterone therapy. We have reviewed the diagnostic methods as well as benefits and risks of testosterone replacement therapy for hypogonadism in aging men.

scholarly journals Why Is Androgen Replacement in Males Controversial?

2011 ◽  
Vol 96 (1) ◽  
pp. 38-52 ◽  
Author(s):  
Glenn R. Cunningham ◽  
Shivani M. Toma
Keyword(s):  
Clinical Trials ◽  
Replacement Therapy ◽  
Evidence Synthesis ◽  
Epidemiological Studies ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Androgen Deficiency ◽  
Testosterone Levels ◽  
Potential Risks ◽  
Low Testosterone

Context: Symptoms and signs consistent with androgen deficiency and low testosterone levels are recognized frequently in clinical practice. Recent population-based epidemiological studies indicate that low testosterone levels in men are associated with increased morbidity and mortality. The clinician must be able to counsel patients to help them determine whether testosterone replacement therapy is appropriate for them. Evidence Acquisition: The authors have conducted a literature search in PubMed, and we have reviewed references in the multiple systematic reviews and meta-analyses that have been published on this topic. Evidence Synthesis: We have attempted to provide the reader with an appreciation of the evidence that can be used to support the diagnosis of androgen deficiency, the efficacy of treatment, the potential risks of treatment, the therapeutic options, and the recommendations for monitoring treatment. Conclusions: We think that published clinical experience justifies testosterone replacement therapy in males who have not initiated puberty by age 14 and in males with low testosterone levels due to classical diseases of the hypothalamic-pituitary-gonadal axis. The benefit:risk ratio is less certain in older men and in those with chronic diseases associated with low testosterone levels. The decision to treat in this setting is much more controversial because there are few large clinical trials that have demonstrated efficacy and no large clinical trials that have determined potential risks of increasing the incidence of clinical prostate cancers or cardiovascular events. We provide a critical review of the evidence that supports treatment and potential risks and ways to reduce the risks if the physician and patient elect testosterone replacement.

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