Testosterone replacement therapy: current trends and future directions

Nieschlag, Eberhard; Behre, Hermann M.; Bouchard, P.; Corrales, J. J.; Jones, T. Hugh; Stalla, Günter; Webb, Starr; Wu, Fcw

doi:10.1093/humupd/dmh035

Cited by 191 publications

(147 citation statements)

References 67 publications

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“…This has also been confirmed in other studies establishing symptom-specific thresholds of androgen levels [1,2,[25][26][27]. It, therefore, comes as no surprise that there is a significant variation among clinics and European countries in their application of threshold values of testosterone signifying hypogonadism which range from 7.5 to 12.0 nmol L -1 [28]. Almost certainly a factor in this observation is that physicians in different countries will have different concepts of what constitute the core symptoms of hypogonadism.…”

Section: Thresholds and Dose-response Relationships Of Androgen Effectssupporting

confidence: 72%

Androgens and male aging: current evidence of safety and efficacy

Gooren¹

2010

Asian J Androl

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Many signs of aging, such as sexual dysfunction, visceral obesity, impaired bone and muscle strength, bear a close resemblance to features of hypogonadism in younger men. The statistical decline of serum testosterone in aging men is solidly documented. It has been presumed that the above features of aging are related to the concurrent decline of androgens, and that correction of the lower-than-normal circulating levels of testosterone will lead to improvement of symptoms of aging. But in essence, the pivotal question whether the age-related decline of testosterone must be viewed as hypogonadism, in the best case reversed by testosterone treatment, has not been definitively resolved. Studies in elderly men with lower-than-normal testosterone report improvement of features of the metabolic syndrome, bone mineral density, of mood and of sexual functioning. But as yet there is no definitive proof of the beneficial effects of restoring testosterone levels to normal in elderly men on clinical parameters. Few of these studies meet as yet rigorous standards of scientific enquiry: double-blind, placebo-controlled design of the study. The above applies also to the assessment of safety of testosterone administration to elderly men. There is so far no convincing evidence that testosterone is a main factor in the development of prostate cancer in elderly men and guidelines for monitoring the development of prostate disease have been developed. It is of note that there are presently no long-term safety data with regard to the prostate. Polycythemia is another potential complication of testosterone treatment. It is dose dependent and can be managed with dose adjustment.

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Section: Thresholds and Dose-response Relationships Of Androgen Effectssupporting

confidence: 72%

Androgens and male aging: current evidence of safety and efficacy

Gooren¹

2010

Asian J Androl

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“…In this study, we have only used biochemical parameters in defining hypogonadism. The levels of 10 nmol/l for total testosterone and 10 IU/l for LH are generally accepted as useful markers of hypogonadism in younger males (22). A shortcoming in current study is the change in the methods for testosterone and LH measurements.…”

Section: Discussionmentioning

confidence: 94%

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Eberhard

Ståhl

Cwikiel

et al. 2008

European Journal of Endocrinology

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Objectives: Testicular germ-cell cancer (TGCC) patients are at risk of developing hypogonadism but no risk factors have yet been defined. Methods: Blood was collected from 143 TGCC patients (after orchidectomy, prior to further therapy (T0) and 6, 12, 24, 36 and 60 months (T6, T12, T24, T36 and T60) after therapy). Biological hypogonadism (BH) was defined as: serum testosterone below 10 nmol/l and/or LH O10 IU/l; odds ratios (ORs) for BH with BH at T0, age, stage of disease, testicular characteristics, and androgen receptor polymorphism as predictors were calculated as well as the OR for developing BH post-treatment (one to two cycles of adjuvant chemotherapy (ACT) versus three to four cycles of higher dose chemotherapy (HCT) versus adjuvant radiotherapy (RT)). Results: HCT increased the OR for BH at T6 (OR 22, 95% confidence interval (CI) 4.4-118) and T12 (OR 5.8, 95% CI 1.5-22). RT increased the OR at T6 (OR 10, 95% CI 2.1-47) and at T12 (OR 3.9, 95% CI 1.1-14). Microlithiasis predicted BH at T0 (OR 11, 95% CI 1.2-112), T12 (OR 3.9, 95% CI 1.1-13), T24 (OR 3.0, 95% CI 1.0-8.8), T36 (OR 5.4, 95% CI 1.7-17) and T60 (OR 4.4, 95% CI 1.2-16). BH at T0 was a risk for BH at T6 (OR 53,, T12 (OR 125, 95% CI 37-430), T24 (OR 88, 95% CI 26-300) and T36 (OR 121, 95% CI 32-460). Conclusions: It is clinically relevant that BH at T0 and testicular microlithiasis were predictive factors for post-treatment BH. HCT and RT gave temporary BH.

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“…Review studies have suggested that the most frequently observed health benefits of TRT include improvements in sexual function, mood and quality of life, muscle strength, and cognitive function; and increased bone mineral density (Nieschlag et al 2004;Bassil et al 2009;Fernández-Balsells et al 2010). These studies have, however, also indicated that TRT may increase the risk of prostate and breast cancers, liver toxicity and tumors, testicular atrophy, infertility, gynecomastia, erythrocytosis, and skin diseases; may worsen benign prostatic hypertrophy; and could exacerbate sleep apnea.…”

Section: Effects Of Testosteronementioning

confidence: 99%