Testosterone replacement therapy for male hypogonadism: Part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents

Seftel, Allen D.

doi:10.1038/sj.ijir.3901366

Cited by 59 publications

(68 citation statements)

References 95 publications

(118 reference statements)

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“…64,65,120,129,130 Topical testosterone formulations such as a patch or gel require daily applications, whereas testosterone supplementation using longacting parenteral formulations provides stable circulating levels but require deep intramuscular injections or subcutaneous pellet implants. Furthermore, exogenous testosterone therapy is associated with known adverse effects including raised hematocrit.…”

Section: Testosterone Cardiovascular Risk and Mortality In Aging Menmentioning

confidence: 99%

“…131,132,134 Testosterone therapy can be offered to hypogonadal men who meet accepted criteria for the diagnosis of androgen deficiency, with monitoring for efficacy and safety during treatment. 120,130,[135][136][137][138][139] Use of accurate, reliable and validated testosterone assays is important. 138,139 However, even with careful clinical and biochemical evaluation, symptomatic androgen deficiency may not be a stable physical state as up to half of men initially classified as such no longer met the criteria when reassessed after an interval of time.…”

Section: Testosterone Cardiovascular Risk and Mortality In Aging Menmentioning

confidence: 99%

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Are declining testosterone levels a major risk factor for ill-health in aging men?

Yeap

2008

Int J Impot Res

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As men grow older, testosterone levels fall, with a steeper decline in unbound or free testosterone compared with total testosterone concentrations. Lower testosterone levels have been associated with poorer cognitive function, and with impaired general and sexual health in aging men. Recently, lower testosterone levels have been linked with metabolic syndrome and type II diabetes, both conditions associated with cardiovascular disease, and shown to predict higher overall and cardiovascular-related mortality in middle-aged and older men. However, reverse causation has to be considered, as systemic illness may result in reduced testosterone levels. Thus, the strength of these associations and the likely direction of causation need to be carefully considered. Furthermore, these conditions may overlap, for example aging, lower testosterone levels, erectile dysfunction and cardiovascular disease are interrelated. Cross-sectional and longitudinal observational studies may be informative. However, ultimately randomized controlled trials of testosterone therapy are needed to clarify its role in the maintenance of general and sexual health in aging men. Testosterone therapy should be considered in hypogonadal men who meet rigorous criteria for the diagnosis of androgen deficiency. Additional consideration should be given to designing and testing interventions that may prevent or ameliorate the age-related decline in testosterone levels in men.

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Section: Testosterone Cardiovascular Risk and Mortality In Aging Menmentioning

confidence: 99%

Section: Testosterone Cardiovascular Risk and Mortality In Aging Menmentioning

confidence: 99%

Are declining testosterone levels a major risk factor for ill-health in aging men?

Yeap

2008

Int J Impot Res

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“…[7][8][9][10][11][12][13][14] In the brain, steroids focus attention toward sexual stimuli and identify them as sexual in nature. 15 Testosterone has a variety of effects systemically and as a neurohormone; because of its wide-ranging impact on multiple body systems, its role in facilitating the sexual response may be underappreciated.…”

Section: Neurohormones and Male Sexual Functionmentioning

confidence: 99%

“…9 This argues, at least in part, for a CNS mechanism of action of testosterone. In addition, nocturnal penile tumescence is impaired in hypogonadal men, but is restored in men who undergo testosterone replacement therapy.…”

Section: Neurohormones and Male Sexual Functionmentioning

confidence: 99%

Clinical applications of centrally acting agents in male sexual dysfunction

Hellstrom

2008

Int J Impot Res

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Currently available agents for erectile dysfunction (ED) share the same mechanism of action and pharmacologic properties. Therefore, they share the same limitations, including a principal focus on erection as an end-organ process. One of the relatively unexplored areas of research has been the potential for centrally acting agents to improve male sexual response. A variety of neurohormones and neurotransmitter systems are involved in the male sexual response, including testosterone, dopamine, serotonin and the melanocortin systems. Investigations to determine the utility of centrally acting agents as monotherapy or adjunctive therapy in men with ED or other forms of sexual dysfunction are underway. Bremelanotide, a melanocortin agonist, has been tested in men with ED and may prove to be one of the first centrally acting agents to have clinical utility in male sexual dysfunction.

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“…Various delivery methods are available for testosterone therapy, including oral preparations, transdermal gels, buccal formulations, subcutaneous implants and intramuscular injections. [31][32][33] Oral preparations Oral testosterone undecanoate (TU) has been available since the early 1970s. Oral TU is co-absorbed with a lipophilic solvent from the intestine into the lymphatic system, thereby circumventing first-pass inactivation in the liver.…”

Section: Trt and The Efficacy Of Trt In Symptomatic Korean Loh Patientsmentioning

confidence: 99%

Testosterone replacement therapy for late-onset hypogonadism: current trends in Korea

Ko¹,

Kim²

2011

Asian J Androl

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Testosterone levels in men older than 40 years can decrease at a rate of 1%-2% per year, and reports show that more than 50% of 80-year-old men have testosterone levels consistent with hypogonadism. Late-onset hypogonadism (LOH) is a clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms of serum testosterone deficiency. In recent decades, the concept of LOH in ageing men has become familiar in European countries and the United States. It is also a topic of interest and debate throughout Korea. However, most of the data regarding advantages or disadvantages of testosterone replacement therapy (TRT) as treatment for LOH have been primarily obtained from studies on Western populations; therefore, studies of the effects of TRT in Asian men, who may have different serum testosterone compared to Western men, are needed. TRT is commonly prescribed in Korea, despite the paucity of studies on the effects of TRT in Asian populations. Data from various TRT studies based on Korean have shown its efficacy in increasing serum testosterone levels and improving subjective symptoms as assessed by questionnaires. Currently, patches and short-acting intramuscular injections are displaced by gels and long-acting formulations. However, to prevent overdiagnosis and overtreatment, indication for TRT should include both low testosterone levels and symptoms and signs of hypogonadism. Keywords: androgens; androgenic agents; late-onset hypogonadism; testosterone replacement therapy INTRODUCTION Late-onset hypogonadism (LOH) is a clinical and biochemical syndrome associated with advancing age resulting from age-related changes in the interactions between hypothalamus/pituitary factors and testicular factors. This syndrome is characterized by typical symptoms of serum testosterone deficiency. Increased longevity and population ageing are expected to result in an increase in the number of men with LOH. Therefore, social interest in testosterone replacement therapy (TRT) has increased over the past few decades.In recent decades, LOH in ageing men has become common in European countries and the United States, 1,2 and it has also attracted interest in Korea. An epidemiological research study conducted via email of 5795 Korean men of at least 40 years of age, using the Androgen Deficiency in Aging Men (ADAM) questionnaire, revealed that 64.6% of respondents had symptoms of LOH, and more than 50% of respondents complained of a decline in erection, endurance and/or sexual desire. When asked whether they intended to undergo TRT, 96% of respondents who complained of erectile dysfunction and decreased endurance and/or sexual desire said that they would accept treatment. 3 To provide appropriate guidelines for investigation, treatment and monitoring of LOH in ageing Korean men, the academic committee of the Korean Society for Aging Male Research released guidelines on LOH in men in 2006. 4 Currently, TRT in Korea is a commonly used LOH treatment modality and is prescribed not only by urologists, but also...

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Testosterone replacement therapy for male hypogonadism: Part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents

Cited by 59 publications

References 95 publications

Are declining testosterone levels a major risk factor for ill-health in aging men?

Are declining testosterone levels a major risk factor for ill-health in aging men?

Clinical applications of centrally acting agents in male sexual dysfunction

Testosterone replacement therapy for late-onset hypogonadism: current trends in Korea

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