Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study

Wallis, Christopher J.D.; Lo, Kirk; Lee, Yuna; Krakowsky, Yonah; Garbens, Alaina; Satkunasivam, Raj; Herschorn, Sender; Kodama, Ronald; Cheung, Patrick; Narod, Steven A.; Nam, Robert K.

doi:10.1016/s2213-8587(16)00112-1

Cited by 133 publications

(91 citation statements)

References 27 publications

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“…The last 2 decades have witnessed a revolution in medical management of men with testosterone (T) deficiency (TD; also known as hypogonadism) [123456789101112131415]. TD has been recognized for more than 7 decades [161718] and T therapy has been used clinically, as early as 1940, both in men and women [161718].…”

Section: Introductionmentioning

confidence: 99%

Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return?

Traish

2016

Investig Clin Urol

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Although testosterone therapy in men with testosterone deficiency was introduced in the early 1940s, utilization of this effective treatment approach in hypogonadal men is met with considerable skepticism and resistance. Indeed, for decades, the fear that testosterone may cause prostate cancer has hampered clinical progress in this field. Nevertheless, even after considerable knowledge was acquired that this fear is unsubstantiated, many in the medical community remain hesitant to utilize this therapeutic approach to treat men with hypogonadism. As the fears concerning prostate cancer have subsided, a new controversy regarding use of testosterone therapy and increase in cardiovascular disease was introduced. Although the new controversy was based on one ill-fated clinical trial, one meta-analysis with studies that utilized unapproved formulation in men with liver cirrhosis, and two retrospective studies with suspect or nonvalidated statistical methodologies and database contaminations, the flames of such controversy were fanned by the lay press and academics alike. In this review we discuss the adverse effect of testosterone deficiency and highlight the numerous proven benefits of testosterone therapy on men's health and debunk the myth that testosterone therapy increases cardiovascular risk. Ultimately, we believe that there is considerable scientific and clinical evidence to suggest that testosterone therapy is safe and effective with restoration of physiological levels in men with testosterone deficiency, irrespective of its etiology.

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Section: Introductionmentioning

confidence: 99%

Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return?

Traish

2016

Investig Clin Urol

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“…In contrast to other age-related diseases, prostate cancer, which is the most prevalent cancer and one of the leading causes of cancer death in men, could be promoted by androgen [4]. More importantly, a greater awareness of the potential risks associated with the treatment in aged men, particularly in regard to cardiovascular risk and mortality, have been shown [56,57]. There is an urgent need for randomized clinical trials with sufficient size, duration and power to determine specific risks and benefits of TRT in older men.…”

Section: Androgen-deprivation Therapy Late-onset Hypogonadism (Loh) mentioning

confidence: 99%

The biological and clinical advances of androgen receptor function in age-related diseases and cancer [Review]

Takayama

2017

Endocr J

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Abstract. Hormonal alterations with aging contribute to the pathogenesis of several diseases. Androgens mediate their effects predominantly through binding to the androgen receptor (AR), a member of the ligand-dependent nuclear receptor superfamily. By androgen treatment, AR is recruited to specific genomic loci dependent on tissue specific pioneer factors to regulate target gene expression. Recent studies have revealed the epigenetic modulation by AR-associated histone modifiers and the roles of non-coding RNAs in AR signaling. Androgens are male sex hormone to induce differentiation of the male reproductive system required for the establishment of adult sexual function. As shown by several reports using AR knockout mouse models, androgens also have anabolic functions in several tissues such as bone, muscle and central nervous systems. Notably, AR has a central role in prostate cancer progression. Prostate cancer is the most frequently diagnosed cancer in men. Androgen-deprivation therapy for cancer patients and decline of serum androgen with aging promote several diseases associated with aging and quality of life of older men such as osteoporosis, sarcopenia and dementia. Thus, androgen replacement therapy for treating late onset hypogonadism (LOH) or new epigenetic regulators have the potential to overcome the symptoms caused by the low androgen, although adverse effects for cardiovascular diseases have been reported. Given the increasing longevity and consequent rise of age-related diseases and prostate cancer patients, a more understanding of the AR actions in male health remains a high research priority.

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“…Однако, учиты-вая ограниченное число участников, а также факторы, ограничивающие возможности интерпретации мета-анализа, можно говорить о необходимости проведе-ния дополнительных крупных исследований, которые позволили бы рассмотреть вопрос о метаболических эффектах ТЗТ и ее долгосрочных эффектах в отно-шении мужчин с гипогонадизмом при наличии СД. Результаты нескольких ретроспективных исследова-ний показали, что назначение препаратов тестостерона мужчинам с СД2 и дефицитом тестостерона приводит к уменьшению смертности пациентов (уровень 3, сте-пень B) [43,44,75].…”

Section: благоприятные эффекты леченияunclassified

Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

et al. 2017

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Гипогонадизм у мужчин, определяемый как снижение уровня тестостерона в сыворотке крови в сочетании с характерными симптомами и/или признаками (подробно описаны далее), часто встречается при сахарном диабете (СД). Эти рекомендации не охватывают всего диапазона патологий, обусловливающих развитие дефицита тестостерона (гипогонадизма), а фокусиру-ются на его клинических вариантах, характерных для мужчин с диабетом. В рекомендациях представлены данные о распро-страненности гипогонадизма при СД, его этиологии. В разделе «диагностика» подробно представлены особенности анамнеза пациентов с гипогонадизмом при СД, необходимые методы физикального и лабораторного обследования. Отдельно рассмо-трены факторы риска и клинические последствия гипогонадизма. В разделе «выбор методов лечения» представлены возмож-ные варианты лечения таких пациентов с использованием различных средств андрогенной терапии с учетом потребностей мужчины, сохранения его репродуктивной функции и факторов риска. Особое внимание уделено показаниям, противопо-казаниям и факторам риска андрогенной терапии у мужчин с диабетом, особенно в пожилом возрасте. С учетом этого раз-работаны принципы мониторинга проводимого лечения. На основании большого числа исследований продемонстрированы благоприятные эффекты андрогенной заместительной терапии у мужчин с гипогонадизмом и СД. Ключевые слова: гипогонадизм, мужчины, дефицит тестостерона, тестостерон, сахарный диабет, метаболический синдром. Hypogonadism in men, defined as a reduction in serum testosterone in combination with characteristic symptoms and/or signs (described in detail later), is common in diabetes mellitus (DM). These recommendations do not cover the whole range of pathologies that cause the development of testosterone deficiency (hypogonadism), but focus on its clinical variants and characteristic for men with diabetes. The recommendations provide data on the prevalence of hypogonadism in diabetes, its etiology. In the section "diagnostics" the features of anamnesis of patients with hypogonadism with diabetes, the necessary methods of physical and laboratory examination are presented in detail. The risk factors and clinical consequences of hypogonadism are separately examined. In the section "choice of treatment methods", there are possible treatment options for such patients using various androgenic therapies, taking into account the needs of the man, maintaining his reproductive function and risk factors. Particular attention is paid to indications, contraindications and risk factors for androgen therapy in men with diabetes, especially in old age. With this in mind, principles for monitoring the treatment are developed. Based on a large number of studies, favorable effects of androgen replacement therapy in men with hypogonadism and diabetes have been demonstrated. Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

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Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study

Cited by 133 publications

References 27 publications

Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return?

Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return?

The biological and clinical advances of androgen receptor function in age-related diseases and cancer [Review]

Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

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