Long‐term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long‐term registry study

Abstract

AimThe goal of this study was to determine if long-term testosterone (T) therapy in men with hypogonadism, henceforth referred to as testosterone deficiency (TD), ameliorates or improves metabolic syndrome (MetS) components.MethodsWe performed a cumulative registry study of 255 men, aged between 33 and 69 years (mean 58.02 ± 6.30) with subnormal plasma total T levels (mean: 9.93 ± 1.38; range: 5.89–12.13 nmol/l) as well as at least mild symptoms of TD assessed by the Aging Males' symptoms scale. All men received treatment with parenteral T undecanoate 1000 mg (Nebido®, Bayer Pharma, Berlin, Germany), administered at baseline and 6 weeks and thereafter every 12 weeks for up to 60 months. Lipids, glucose, liver enzymes and haemoglobin A1c analyses were carried out in a commercial laboratory. Anthropometric measurements were also made throughout the study period.ResultsTestosterone therapy restored physiological T levels and resulted in reductions in total cholesterol (TC) [7.29 ± 1.03 to 4.87 ± 0.29 mmol/l (281.58 ± 39.8 to 188.12 ± 11.31 mg/dl)], low-density lipoprotein cholesterol [4.24 ± 1.07 to 2.84 ± 0.92 mmol/l (163.79 ± 41.44 to 109.84 ± 35.41 mg/dl)], triglycerides [3.14 ± 0.58 to 2.16 ± 0.13 mmol/l (276.16 ± 51.32 to 189.78 ± 11.33 mg/dl)] and increased high-density lipoprotein levels [1.45 ± 0.46 to 1.52 ± 0.45 mmol/l (56.17 ± 17.79 to 58.85 ± 17.51 mg/dl)] (p < 0.0001 for all). There were marked reductions in systolic and diastolic blood pressure, blood glucose, haemoglobin A1c, C-reactive protein (6.29 ± 7.96 to 1.03 ± 1.87 U/l), alanine aminotransferase and aspartate aminotransferase (p < 0.0001 for all).ConclusionsLong-term T therapy, at physiological levels, ameliorates MetS components. These findings strongly suggest that T therapy in hypogonadal men may prove useful in reducing the risk of cardiometabolic diseases.

Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: An experimental study in the rabbit

“…Androgen deficiency and low circulating T levels have been demonstrated to be independently associated with NAFLD/NASH (Kim et al, 2012;Völzke et al, 2010). Recently, several reports demonstrated that raising serum T concentrations to normal levels in hypogonadal patients by treatment with parenteral T, along with improving metabolic profile, significantly reduces the levels of liver transaminases (Haider et al, 2010;Traish et al, 2013), and circulating TNFa levels (Kalinchenko et al, 2010). In a randomized, double-blind, placebo-controlled study, Hoyos and colleagues showed that 18-week treatment with T significantly reduces liver fat content, as well as decreased arterial stiffness (Hoyos et al, 2012).…”

Pathophysiology, evaluation and treatment of erectile dysfunction: review article

“…Homens portadores de Síndrome Metabólica (SM) são mais suscetíveis a desenvolverem DE 10,11,18,29,30 . Uma pessoa que possui mais de três aspectos metabólicos alterados citados a seguir pode ser diagnosticada como portadora de SM: obesidade central (circunferência da cintura superior a 88 cm na mulher e 102 cm no homem), hipertensão arterial sistêmica (pressão arterial sistólica > 130 e/ou pressão arterial diastólica > 85 mmHg), glicemia alterada (glicemia > 110 mg/dl) ou diagnóstico de diabetes, triglicerídeos > 150 mg/dl, HDL colesterol < 40 mg/dl em homens e < 50 mg/dl em mulheres [31][32][33] . Dados de 100 homens com SM apresentaram elevada prevalência de DE, quando comparados a homens que não possuíam a síndrome (26.7% vs 13%, p=0,03) 34 .…”

Low testosterone and the metabolic syndrome: a high‐risk combination

“…19,20 Androgen deficiency promotes the production of fat cells, which contributes to obesity and the metabolic syndrome. 21 It also results in impaired glucose metabolism, higher levels of triglycerides and cholesterol, and lower levels of high-density lipoprotein (HDL) cholesterol, which are all features of the metabolic syndrome.…”

“…This widespread effect was attributed to common mechanisms of action linking the pathophysiology of both conditions. 21 A small study analysed the effects of supervised diet and exercise with or without transdermal testosterone on components of the metabolic syndrome in hypogonadal men with this syndrome and newly diagnosed type 2 diabetes. After 52 weeks of treatment, 81% of men receiving testosterone no longer met the criteria of the metabolic syndrome versus 31% of those who did not receive testosterone.…”