Testosterone Replacement Therapy: Who to Evaluate, What to Use, How to Follow, and Who is at Risk?

Afiadata, Achankeng; Ellsworth, Pamela

doi:10.3810/hp.2014.12.1160

Cited by 5 publications

(17 citation statements)

References 87 publications

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“…Numerous studies suggest that testosterone replacement in men improves glycemic control [ 41 , 42 , 43 , 44 , 45 ]. Yet, the benefit of testosterone replacement for improved metabolic health in men is controversial [ 8 , 9 , 11 ] because the long-term risk of testosterone replacement in men is linked to increased cardiovascular risk [ 46 , 47 , 48 , 49 ]. Thus, the beneficial effect of testosterone replacement on metabolic health must be balanced against the increased risk for cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

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Testosterone is protective against impaired glucose metabolism in male intrauterine growth-restricted offspring

et al. 2017

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Placental insufficiency alters the intrauterine environment leading to increased risk for chronic disease including impaired glucose metabolism in low birth weight infants. Using a rat model of low birth weight, we previously reported that placental insufficiency induces a significant increase in circulating testosterone in male intrauterine growth-restricted offspring (mIUGR) in early adulthood that is lost by 12 months of age. Numerous studies indicate testosterone has a positive effect on glucose metabolism in men. Female growth-restricted littermates exhibit glucose intolerance at 6 months of age. Thus, the aim of this paper was to determine whether mIUGR develop impaired glucose metabolism, and whether a decrease in elevated testosterone levels plays a role in its onset. Male growth-restricted offspring were studied at 6 and 12 months of age. No impairment in glucose tolerance was observed at 6 months of age when mIUGR exhibited a 2-fold higher testosterone level compared to age-matched control. Fasting blood glucose was significantly higher and glucose tolerance was impaired with a significant decrease in circulating testosterone in mIUGR at 12 compared with 6 months of age. Castration did not additionally impair fasting blood glucose or glucose tolerance in mIUGR at 12 months of age, but fasting blood glucose was significantly elevated in castrated controls. Restoration of elevated testosterone levels significantly reduced fasting blood glucose and improved glucose tolerance in mIUGR. Thus, our findings suggest that the endogenous increase in circulating testosterone in mIUGR is protective against impaired glucose homeostasis.

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Section: Discussionmentioning

confidence: 99%

“…Collectively, these studies indicate that testosterone deficiency in men is a risk factor for diabetes. Yet, whether testosterone replacement has a beneficial effect on glucose metabolism in men is controversial [ 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Testosterone is protective against impaired glucose metabolism in male intrauterine growth-restricted offspring

et al. 2017

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“… 5 , 10 , 11 One guideline endorses screening for men presenting with hypogonadism symptoms, and another includes screening in opioid or glucocorticoid use, chronic disease, obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). 5 , 12 …”

Section: Guideline Comparison Of Screening and Presenting Symptomsmentioning

confidence: 99%

“… 5 , 10 , 11 Afiadata and Ellsworth describe presenting symptoms, which are not explicitly required for diagnosis, and endorse treatment only for symptomatic men. 12 …”

Section: Guideline Comparison Of Screening and Presenting Symptomsmentioning

confidence: 99%

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Approaches to male hypogonadism in primary care

Lawrence

Stewart

Larson

2017

The Nurse Practitioner

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Subcutaneous Leydig Stem Cell Autograft: A Promising Strategy to Increase Serum Testosterone

Arora

Zuttion

Nahar

et al. 2018

Stem Cells Translational Medicine

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Exogenous testosterone therapy can be used to treat testosterone deficiency; however, it has several adverse effects including infertility due to negative feedback on the hypothalamic–pituitary–gonadal (HPG) axis. Leydig stem cell (LSC) transplantation could provide a new strategy for treating testosterone deficiency, but clinical translatability of injecting stem cells inside the testis is not feasible. Here, we explore the feasibility of subcutaneously autografting LSCs in combination with Sertoli and myoid cells to increase testosterone. We also studied whether the grafted LSCs can be regulated by the HPG axis and the molecular mechanism behind this regulation. LSCs were isolated from the testes of 12‐week‐old C57BL/6 mice, and subcutaneously autografted in combination with Sertoli cells and myoid cells. We found that LSCs alone were incapable of self‐renewal and differentiation. However, in combination with Sertoli cells and myoid cells, LSCs underwent self‐renewal as well as differentiation into mature Leydig cells. As a result, the recipient mice that received the LSC autograft showed testosterone production with preserved luteinizing hormone. We found that testosterone production from the autograft was regulated by hedgehog (HH) signaling. Gain of function and loss of function study confirmed that Desert HH (DHH) agonist increased and DHH antagonist decreased testosterone production from autograft. This study is the first to demonstrate that LSCs, when autografted subcutaneously in combination with Sertoli cells and myoid cells, can increase testosterone production. Therefore, LSC autograft may provide a new treatment for testosterone deficiency while simultaneously preserving the HPG axis. Stem Cells Translational Medicine 2019;8:58–65

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Testosterone Replacement Therapy: Who to Evaluate, What to Use, How to Follow, and Who is at Risk?

Cited by 5 publications

References 87 publications

Testosterone is protective against impaired glucose metabolism in male intrauterine growth-restricted offspring

Testosterone is protective against impaired glucose metabolism in male intrauterine growth-restricted offspring

Approaches to male hypogonadism in primary care

Subcutaneous Leydig Stem Cell Autograft: A Promising Strategy to Increase Serum Testosterone

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