The Effect of Longer-Acting vs Shorter-Acting Testosterone Therapy on Follicle Stimulating Hormone and Luteinizing Hormone

Masterson, Thomas A.; Turner, Darren; Vo, Duyen; Blachman‐Braun, Ruben; Best, Jordan C.; Westfield, Gerwin; Bryson, Nathan; Ramasamy, Ranjith

doi:10.1016/j.sxmr.2020.07.006

Cited by 7 publications

(8 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Specifically, it should be borne in mind that individuals who experience severe late-onset hypogonadism tend to require more attention than those who have less severe symptoms to achieve therapeutic goals such as improving the quality of semen or sperm count. (22).…”

Section: Tu (Long-acting) and Short-acting Trt Mechanismmentioning

confidence: 99%

Comparison of short and long-acting testosterone replacement therapy for better sperm production and testosterone levels in male late-onset hypogonadism

Margiana¹,

Abdullah

Ilhamsyah

et al. 2022

ijhs

View full text Add to dashboard Cite

Introduction: Testosterone Replacement Therapy (TRT) is the standard treatment for male late-onset hypogonadism. Short-acting and long-acting testosterone are currently available treatments and have been approved by the Food and Drug Administration (FDA). The administration of exogenous testosterone is known to increase sperm production and T levels in men suffering from late-onset hypogonadism. However, limited research compares the efficacy of these two types of TRT. Objective: This study aims to compare the efficacy of short-acting and long-acting testosterone replacement therapy on sperm production and T levels in men suffering from late-onset hypogonadism. Methods: We searched for electronic databases including PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, Allied and Complementary Medicine Database (AMED), and Google using keywords. All studies were evaluated by three independent reviewers who resolved differences by consensus. Results: We identified 21 studies that met our inclusion criteria. After applying the inclusion criteria, only 21 database sources remain for further analysis. Conclusion: Long-acting formulas affect blood more. RCTs show TU boosts libido and testosterone. Male infertility may result from long-acting TU blocking LH and FSH. TRP improves erections by increasing motile sperm and libido. Peanut allergy-related short-acting TRT causes nausea, itching, and injection-site pain.

show abstract

Section: Tu (Long-acting) and Short-acting Trt Mechanismmentioning

confidence: 99%

Comparison of short and long-acting testosterone replacement therapy for better sperm production and testosterone levels in male late-onset hypogonadism

Margiana¹,

Abdullah

Ilhamsyah

et al. 2022

ijhs

View full text Add to dashboard Cite

show abstract

Section: Testosterone Formulationsmentioning

confidence: 99%

“…1,35 For example, IM injections of testosterone that produce supraphysiological testosterone levels may be more likely to lead to serious AEs, including polycythemia, or such AEs as injection-site pain. 1,36 Additionally, longer-acting testosterone formulations may be more likely to suppress HPG axis function and fertility. 37 The appropriateness and selection of treatment modalities also may be driven by existing individual patient characteristics, such as age, or comorbidities that place certain patients at higher risk for conditions identified in • Short-acting…”

mentioning

confidence: 99%

An Individualized Approach to Managing Testosterone Therapy in the Primary Care Setting

Dobs¹,

Campbell²

2022

IJGM

View full text Add to dashboard Cite

The incidence of testosterone deficiency and the use of testosterone therapy have increased in recent years, and currently the majority of testosterone prescriptions in the United States and Canada are written by primary care physicians. Meanwhile, the range of available testosterone therapy formulations has widened to include buccal tablets, intramuscular injections, transdermal gels, intranasal gel, subcutaneous injections, oral capsules, and subdermal pellets, each with unique pharmacokinetic and clinical characteristics. Despite the growing use of testosterone therapy and its overall efficacy and safety as demonstrated in clinical trials, concerns exist about the potential impact of testosterone therapy on spermatogenesis and fertility, development of prostate cancer, and risk of polycythemia and cardiovascular events. In addition, ongoing research aims to better characterize the effects of testosterone therapy in specific populations, such as patients aged 65 years and older, patients with obesity and type 2 diabetes, and transgender patients. The range of treatment options and the diversity of patients’ goals, preferences, comorbidities, and risk factors necessitate an individualized approach to testosterone therapy that considers each patient’s clinical needs alongside the distinct features of different testosterone formulations.

show abstract

“…23,24 Short acting forms of testosterone, like oral T, are less suppressive than long acting forms of testosterone, and so a combination of oral T and a SERM, Tamoxifen, was hypothesized to provide the benefits of exogenous testosterone while utilizing the negative feedback inhibition of Tamoxifen to promote and maintain gonadotropin secretion. 19,25 A low dose of oral testosterone undecanoate, dosed at 40 mg three times daily, combined with tamoxifen citrate, dosed at 10 mg twice daily, showed no adverse effects on pituitary or Leydig cell activity, and showed improvements in semen parameters compared to the tamoxifen only group. 25 This study revealed three important outcomes regarding the hormonal modulation in response to exogenous T and SERM administration.…”

Section: Introductionmentioning

confidence: 98%

“…All forms of traditional TRT decrease FSH by up to 86.3% and LH up to 71.8%, on average. 19 In healthy eugonadal men subjected to TRT, ITT levels decreased by 94%. 20 Recovery from this suppression is not a certainty after cessation of exogenous testosterone, with some men taking up to 24 months to recover normal sperm count.…”

Section: Introductionmentioning

confidence: 99%

Maximus’ Oral TRT Plus Protocol: A Highly Efficacious and Non-Suppressive Approach to Significantly Enhance Testosterone and Quality of Life in Hypogonadal and Eugonadal Men

Sepah,

Alizaidy,

Henry

et al. 2024

Preprint

View full text Add to dashboard Cite

Purpose: Male hypogonadism, characterized by decreased functionality of the testicles and evidenced by low testosterone levels, requires treatment strategies tailored to the specific type of hypogonadism. Primary hypogonadism, resulting from direct testicular impairment, is typically addressed with testosterone replacement therapy (TRT). In contrast, secondary hypogonadism, stemming from dysfunction in the hypothalamic-pituitary axis, often necessitates alternative treatments aimed at preserving fertility markers. These include Selective Estrogen Receptor Modulators (SERMs), Aromatase Inhibitors, and human chorionic gonadotropin (hCG). Although all treatment options can be effective, TRT uniquely offers dose-dependent benefits, which are not as achievable with alternatives due to their inability to bypass the body's natural testosterone production controls. However, the choice of TRT, particularly for individuals with secondary hypogonadism, involves a trade-off between maximizing treatment efficacy and preserving fertility markers. Our study addresses this dilemma by exploring a novel therapeutic approach, dubbed 'Oral TRT Plus,' which combines two oral medications: oral native testosterone and enclomiphene citrate. This approach aims to provide the dose-dependent benefits of exogenous testosterone while also preserving fertility markers.Materials and Methods: 79 male patients, encompassing both hypogonadal and eugonadal men, participated in a sequence of four distinct experiments. These experiments were designed to determine the ideal dosing, assess the necessity of fat intake for enhanced drug absorption, and identify the most effective timing for blood tests to capture peak testosterone levels. Measurements of various blood markers, including total testosterone, free testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), and sex hormone-binding globulin (SHBG), were obtained using both at-home lab testing kits and in-person venipuncture. In addition, participants completed subjective questionnaires—the quantitative Androgen Deficiency in the Aging Male (qADAM) and the Patient Health Questionnaire-4 (PHQ-4)—to evaluate subjective improvements in hypogonadal symptoms during the treatment.Results: With optimized dosing, total testosterone levels in both eugonadal and hypogonadal men increased fourfold and free testosterone fivefold (both p < 0.025), surpassing the 99th percentile for both measurements in all participants. Meanwhile, LH and FSH levels remained within normal ranges across all participants (p < 0.025), demonstrating the treatment's ability to preserve fertility markers irrespective of the increased testosterone dosing. Estrogen levels significantly decreased but stayed within normal limits. Subjective health measures improved notably; over 70% of participants reported enhanced energy, strength/endurance, improved work performance, and quality of life according to qADAM scores, with significant reductions in anxiety and depression symptoms evidenced by 97% of participants reporting normal function (both p<0.001). Conclusions: Both eugonadal and hypogonadal men utilizing the “Oral TRT Plus Protocol” demonstrated a fivefold increase in free testosterone levels on average, while simultaneously mitigating endogenous suppression and preserving fertility markers. This protocol elicited significant improvements across various subjective health metrics, including quality of life, energy, strength, mood, libido, and work performance, alongside a marked decrease in anxiety and depression symptoms. Furthermore, the protocol effectively regulated estrogen levels within normal physiological ranges, eliminating the necessity for adjunctive medications. The “Oral TRT Plus Protocol” aligns with the evolving landscape of telemedicine by demonstrating how advanced hormonal treatment regimens can be effectively administered and monitored remotely, offering an innovative, non-invasive strategy for enhancing men's mental, physical, and hormonal health while preserving fertility markers.

show abstract

The Effect of Longer-Acting vs Shorter-Acting Testosterone Therapy on Follicle Stimulating Hormone and Luteinizing Hormone

Cited by 7 publications

References 17 publications

Comparison of short and long-acting testosterone replacement therapy for better sperm production and testosterone levels in male late-onset hypogonadism

Comparison of short and long-acting testosterone replacement therapy for better sperm production and testosterone levels in male late-onset hypogonadism

An Individualized Approach to Managing Testosterone Therapy in the Primary Care Setting

Maximus’ Oral TRT Plus Protocol: A Highly Efficacious and Non-Suppressive Approach to Significantly Enhance Testosterone and Quality of Life in Hypogonadal and Eugonadal Men

Contact Info

Product

Resources

About