Predictors and clinical consequences of starting androgen therapy in men with low testosterone: results from the SIAMO-NOI registry

2019

EJEA

Sexual Dysfunction a useful correlate to define a symptomatic LOH. 3,5-7 By restricting the construct of LOH to those having both TD and the aforementioned sexual symptoms, the figure of its representation in Europe is dramatically reduced, i.e., 2.1% of the European general population older than 40 years. 3 The presence of a specific association between sexual symptoms and TD is not enough to establish the direction of the relationship; in fact, it is possible that TD is responsible for causing the symptoms or the other way around. Longitudinal extensions of the EMAS studies clarified that the development of both primary and secondary hypogonadism predicts the occurrence or worsening of sexual symptoms at follow-up. 5,8 On the other hand, the incidence or worsening of these symptoms is not negligible-although lower than in men developing primary or secondary hypogonadism-even among men who remain eugonadal during the follow-up. 5,8 This suggests that factors other than TD play a role in determining sexual symptoms compatible with those of LOH. Intervention studies are useful in defining causality in the relationship between TD and sexual symptoms. In particular, it is

Section: Discussionmentioning

confidence: 99%

Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction

Rastrelli

Corona

2019

EJEA

“…Opioids can induce several hypogonadism-related signs and symptoms, including sexual dysfunction, mood impairment, fatigue, weight gain and osteoporosis [ 16 – 18 , 86 ], and these are described in more detail in the following sections. Regardless of the origin of hypogonadism, signs and symptoms are dependent on the age at onset [ 87 , 88 ]. In adults and aging men, sexual dysfunction is the most specific symptom associated with low testosterone [ 89 – 91 ].…”

Section: Methodsmentioning

confidence: 99%

Testosterone deficiency in non-cancer opioid-treated patients

Coluzzi

Billeci

et al. 2018

J Endocrinol Invest

Self Cite

PurposeThe use of opioids in patients with chronic non-cancer pain is common and can be associated with opioid-induced androgen deficiency (OPIAD) in men. This review aims to evaluate the current literature regarding the prevalence, clinical consequence and management of OPIAD.MethodsA database search was performed in Medline, Embase and Cochrane using terms such as “analgesics”, “opioids” and “testosterone”. Relevant literature from January 1969 to March 2018 was evaluated.ResultsThe prevalence of patients with OPIAD ranges from 19 to 86%, depending on the criteria for diagnosis of hypogonadism. The opioid-induced suppression of gonadotropin-releasing and luteinizing hormones represents the main important pathogenetic mechanisms. OPIAD has significant negative clinical consequences on sexual function, mood, bone density and body composition. In addition, OPIAD can also impair pain control leading to hyperalgesia, which can contribute to sexual dysfunction and mood impairment.ConclusionsOPIAD is a common adverse effect of opioid treatment and contributes to sexual dysfunction, impairs pain relief and reduces overall quality of life. The evaluation of serum testosterone levels should be considered in male chronic opioid users and the decision to initiate testosterone treatment should be based on the clinical profile of individuals, in consultation with the patient.

“…96 Similar results were derived from another Italian registry (SIAMO-NOI), which collected data from 432 men with hypogonadism in 15 centers. 98 In addition, data derived from either animal models or clinical observations have documented that HG is characterized by an increased prostate inflammation, particularly evident in patients with obesity and metabolic disorders, which can contribute to benign prostatic hyperplasia-related symptoms and can be improved by TRT, explaining, at least partially, the aforementioned observations. Accordingly, preliminary data from a placebo-controlled RCT, involving 120 men with MetS and benign prostatic hyperplasia, showed that TRT produced a moderate improvement in lower urinary tract symptoms, associated with a significant decline in prostate artery flow velocity and acceleration, as assessed by transrectal color Doppler ultrasound, and with a decrease, in the prostatic tissue, of the expression of some inflammation-related genes, such as cyclooxygenase-2, monocyte chemoattractant protein-1, and related orphan receptor gamma-t. 99 A final point to be discussed is related to the effect of TRT in men treated for PC.…”

Section: Prostatementioning

confidence: 99%

Testosterone Therapy: What We Have Learned From Trials

Corona

Torres

The Journal of Sexual Medicine

2020

Introduction: The role of testosterone (T) replacement therapy (TRT) in men is still conflicting. In particular, safety concerns and cardiovascular (CV) risk related to TRT have not been completely clarified yet. Similarly, the clear beneficial effects of TRT are far to be established. Aim: To systematically and critically analyze the available literature providing evidence of the benefit-risk ratio derived from TRT in aging men. Methods: A comprehensive PubMed literature search was performed to collect all trials, either randomized controlled trials (RCTs) or observational studies, evaluating the effects of TRT on different outcomes. Main Outcome Measure: Whenever possible, data derived from RCTs were compared with those resulting from observational studies. In addition, a discussion of the available meta-analyses has been also provided. Results: Data derived from RCT and observational studies clearly documented that TRT can improve erectile function and libido as well as other sexual activities in men with hypogonadism (total T < 12 nM). Conversely, the effect of TRT on other outcomes, including metabolic, mood, cognition, mobility, and bone, is more conflicting. When hypogonadism is correctly diagnosed and managed, no CV venous thromboembolism or prostate risk is observed. Clinical Implications: Before prescribing TRT, hypogonadism (total T < 12 nM) must be confirmed through an adequate biochemical evaluation. Potential contraindications should be ruled out, and an adequate follow-up after the prescription is mandatory. Strength & Limitations: When correctly diagnosed and administered, TRT is safe, and it can improve several aspects of sexual function. However, its role in complicated vasculogenic erectile dysfunction is limited. Conversely, TRT is not recommended for weight reduction and metabolic improvement. Further well-powered studies are advisable to better clarify TRT for long-term CV risk and prostate safety in complicated patients as well as in those curatively treated for prostate cancer. Conclusion: TRT results in sexual function improvement when men with hypogonadism (total T < 12 nM) are considered. Positive data in other outcomes need to be confirmed.