Lost Libido is Restored with Testosterone Replacement
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Advanced Age Management offers Testosterone Replacement Therapy. This mens clinic is located near Cleveland, OH, and it gives men the perfect solution if they are feeling sluggish, low energy, gaining weight, or they have a decreased sex drive. Advanced Age Management says if youre over the age of 35, you could have low testosterone, and this is normal as you get older, but you will start to notice issues more and more as you age.
This mens clinic in Cleveland, OH, says it is due to a condition called Hypergonadism, yet, they want to reassure individuals who may be concerned and worried that their testosterone production level is low, that is why they are now offering testosterone replacement therapy in their clinic. If you are suffering from one of the issues mentioned above, definitely consider scheduling an appointment with your doctor and get your testosterone levels checked. Contact Advanced Age Management, and they will advise you on your next step and get you in for a free testosterone assessment.
At Advanced Age Management, their goal is to help men build up their testosterone levels by testing testosterone levels and creating a treatment plan to get the testosterone levels back to an appropriate level so that each individual does not have to suffer anymore and can carry on with their life. This is all done through the testosterone replacement therapy at their mens clinic.
It would be best if you got in touch with Dr. John Kocka at Advanced Age Management, a low testosterone expert who carries out a series of assessments and testosterone replacement therapy for men and women in and around Cleveland Ohio. According to Advanced Age Management, the cost of the testosterone replacement therapy varies from each patient to the next, as each person will require a different treatment plan. You can, however, schedule a free consultation and also review your financial information with Dr. John Kocka once you get in touch.
Advanced Age Management emphasizes that the therapy offered to men is only for those with testosterone deficiencies, which is why this mens clinic is the best to consult with if you have found out that you have low testosterone. If needed, Dr.Kocka can offer you a same-day consultation.
If you have been given the go-ahead for testosterone replacement therapy, Advanced Age Management assures you that there are many benefits of testosterone treatment. There is evidence to suggest the therapy can improve your cardiovascular health by removing cholesterol from your arteries, a common issue that many men suffer with as they get older.
The mens clinic in Cleveland, OH, assists men for other hormone treatments as well, such as DHEA, cortisol, thyroid, natural growth hormone, insulin, and more.
Contact Advanced Age Management today at (330) 439-6591 and schedule your free consultation with one of their low testosterone doctors. This mens clinic is offering you the chance to increase your testosterone levels and, in turn, improve your health and overall well-being. At Advanced Age Management, the doctors use injection therapy for men who need more testosterone production. You can read more about low testosterone and the testosterone replacement therapy on their website at https://www.lowtohio.com.
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AMA recently published a detailed study of over 180+ pages in its repository on Testosterone Replacement Therapy market covering interesting aspects of market with supporting development scenario till 2025. The study provides market size break-up by revenue and volume* for emerging countries and important business segments along with commentary on trending factors, growth drivers. Profiled players in study from the coverage used under bottom-up approach are AbbVie Inc. (United States), Endo International (Ireland), Eli Lilly and Company (United States), Pfizer (United States), Bayer (Germany), Actavis (Allergan) (United States), Novartis (Switzerland), Teva (Israel), Ferring Pharmaceuticals (Switzerland), Kyowa Kirin (Japan), Mylan (United States)
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Testosterone is responsible for the development of male sexual characteristics and this hormone formed by the testicles. Insufficient production of testosterone causes erectile dysfunction. Testosterone Replacement Therapy (TRT) is generally termed as hormone therapy for men, designed to counteract the effects of reduced activity in the gonads or hypogonadism. Hypogonadism in men is clinical syndrome, which results in the failure of the testes to produce physiological levels of testosterone. Erectile dysfunction arises due to reduce testosterone production to overcome this testosterone replacement therapy is used to improve the problem.
Market Segmentationby Type (Creams or Gels, Patches, Injections, Buccal Adhesives, Implants, Oral), Application (Hospitals, Clinics)
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Whats Trending in Market: Increasing awareness about testosterone substitute therapy
Growth Drivers: Increasing prevalence of hypogonadism in adult men
The need for having an offspring amongst men
Restraints: High possibility of side effects related to testosterone replacement therapy
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Country level Break-up includes:North America (United States, Canada and Mexico)Europe (Germany, France, United Kingdom, Spain, Italy, Netherlands, Switzerland, Nordic, Others)Asia-Pacific (Japan, China, Australia, India, Taiwan, South Korea, Middle East & Africa, Others)
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Global Testosterone Replacement Therapy
By Type (Creams or Gels, Patches, Injections, Buccal Adhesives, Implants, Oral)
By Application (Hospitals, Clinics)
Global Testosterone Replacement Therapy Region
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Europe (Germany, France, United Kingdom, Spain, Italy, Netherlands, Switzerland, Nordic, Others)
Asia-Pacific (Japan, China, Australia, India, Taiwan, South Korea, Middle East & Africa, Others)
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Competitive Landscape (Direct & Indirect Competitors), Market Share Analysis, Peer Group Analysis (2018), BCG Matrix, Company Profile, Downstream Buyers & Upstream Suppliers
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This new research report that entirely centers Global Testosterone Replacement Therapy Market 2019 is an exhaustive analysis of driving forces, risks, challenges, threats, and business opportunities, involved in the Testosterone Replacement Therapy market. It offers conclusive specks of the market such as major leading players, market size over the forecast period of eight years, segmentation analysis, market share, current market trends, movements and major geographical regions involved. The report includes a comprehensive market study and competitors landscape with the addition of a SWOT study of the leading vendors.
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Some of the Major Testosterone Replacement Therapy Market Players Are:
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The global Testosterone Replacement Therapy market report covers scope and product overview to describe the key terms and offers detailed information about market dynamics to the readers.
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Testosterone Replacement Therapy market regional Analysis
The global Testosterone Replacement Therapy market is fragmented across the globe which not only includes the market of North America but covers the other regions such as Europe, the Asia Pacific, South America, and the Middle East.
North American countries, especially the U.S. and Canada represent noteworthy growth in this market. Similarly, Western European regions are also ahead in influencing the global markets.
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Financing to speed commercialization of the only FDA-approved oral treatment of its kind for testosterone deficiency1,2
NORTHBROOK, Ill., March 16, 2020 (GLOBE NEWSWIRE) -- Clarus Therapeutics, Inc., a commercial mens health specialty pharmaceutical company, announced today that it has completed a senior debt financing of up to $75M. Morgan Stanley & Co. LLC acted as sole placement agent for the transaction.
Clarus will use the proceeds from this financing to accelerate the commercialization strategy and launch for JATENZO (testosterone undecanoate) capsules, CIII, the first and only FDA-approved oral softgel testosterone replacement therapy for the treatment of men with hypogonadism due to certain medical conditions. This additional investment builds on an exceptional year for the company, which includes hiring multiple key executives and making JATENZO available for patients.
We are thrilled to have this investment as we bring JATENZO to market, said Dr. Robert Dudley, Chief Executive Officer of Clarus Therapeutics, Inc. We can now fully implement JATENZOs commercialization strategy and move Clarus closer to profitability.
About HypogonadismHypogonadism, also known as testosterone deficiency, is a condition in men in which the body does not produce enough testosterone.3 Only those men who are symptomatic and have consistently low results on a reliable testosterone assay should be offered testosterone replacement therapy, according to current treatment guidelines from both the Endocrine Society and the American Urological Association.3,4 Treatment is meant to induce and maintain secondary sex characteristics and improve clinical symptoms associated with testosterone deficiency.4About Clarus Therapeutics, Inc.Clarus is a men's specialty pharmaceutical company developing and commercializing JATENZO, a product protected by patents issued in the United States and in other major pharmaceutical markets around the world. Clarus owns the worldwide, royalty-free commercialization rights for JATENZO.For more information, please visit:www.clarustherapeutics.com.
About JATENZO JATENZO is the first and only FDA-approved oral testosterone undecanoate for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone: primary hypogonadism (congenital or acquired) and hypogonadotropic hypogonadism (congenital or acquired).1,2
JATENZOs proprietary formulation is built around testosterone undecanoatea testosterone prodrug that the body converts to testosterone. In the JATENZO pivotal inTUne (investigational testosterone undecanoate) clinical trial, 87 percent of hypogonadal men treated with JATENZO achieved a mean total testosterone concentration in the eugonadal range at the end of treatment.1 The efficacy and safety of JATENZO was evaluated in 166 adult, hypogonadal males in a 4-month, open-label study. The primary endpoint was the percentage of patients with mean plasma total testosterone concentration (Cavg) over 24 hours within the normal eugonadal range on the final pharmacokinetic visit of the study.
INDICATIONJATENZO (testosterone undecanoate) capsules, CIII, is an androgen indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone:
Limitation of use
Safety and efficacy of JATENZO in males less than 18 years old have not been established.
IMPORTANT SAFETY INFORMATION
WARNING: INCREASES IN BLOOD PRESSURE
CONTRAINDICATIONS
JATENZO is contraindicated in men with carcinoma of the breast or known or suspected carcinoma of the prostate, in women who are pregnant, in men with a known hypersensitivity to JATENZO or its ingredients, or in men with hypogonadal conditions that are not associated with structural or genetic etiologies as JATENZO has not been established for these conditions and there is a risk of increased blood pressure with JATENZO that can increase the risk of MACE.
WARNINGS AND PRECAUTIONS
ADVERSE EVENTS
The most common adverse events of JATENZO (incidence 2%) are headache (5%), increased hematocrit (5%), hypertension (4%), decreased HDL (3%), and nausea (2%).
DRUG INTERACTIONS
USE IN SPECIFIC POPULATIONS
The safety and efficacy of JATENZO in pediatric patients less than 18 years old have not been established. Improper use may result in acceleration of bone age and premature closure of epiphyses.
There have not been sufficient numbers of geriatric patients involved in controlled clinical studies utilizing JATENZO to determine whether efficacy or safety in those over 65 years of age differs from younger subjects. There is insufficient long-term safety data in geriatric patients utilizing JATENZO to assess the potentially increased risk of cardiovascular disease and prostate cancer.
Please click here for full Prescribing Information, including BOXED WARNING on increases in blood pressure.
Media ContactAmir KhanPhone: (212) 462-8767Email: Amir.Khan@Syneoshealth.com
1JATENZO (testosterone undecanoate) [prescribing information]. Clarus Therapeutics, Inc.
2US Food & Drug Administration. FDA Approved Drug Products. Available at: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=206089. Accessed October 1, 2019.
3Bhasin S, et al. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
4Mulhall JP, et al. J Urol. 2018;200(2):423-432.
2020 Clarus Therapeutics, Inc. All rights reserved.
JATENZO is a registered trademark of Clarus Therapeutics, Inc.
COR-US-0038 03/2020
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CLARUS THERAPEUTICS ANNOUNCES FINANCING TO SUPPORT THE COMMERCIAL LAUNCH AND AVAILABILITY OF JATENZO (TESTOSTERONE UNDECANOATE) CAPSULES, CIII FOR THE...
Law360, Chicago (November 6, 2019, 2:28 PM EST) -- A Seventh Circuit judge on Wednesday pushed Medical Mutual of Ohio to address why it waited until July 2016 to take steps to limit which testosterone replacement drugs the insurer would cover, two years after the U.S. Food and Drug Administration flagged potential cardiovascular risks associated with the drugs.
During oral arguments, Medical Mutual urged the Seventh Circuit to revive its Racketeer Influenced and Corrupt Organizations Act suit against AbbVie and other makers of testosterone replacement drugs, or TRTs, saying they misrepresented those drugs as being safe and effective for a host of symptoms related to normal male aging.
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Understand the potential risks and consider alternatives before boosting your hormones indefinitely.
Millions of American men use a prescription testosterone gel or injection to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that treating "low T" this way can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone could face higher cardiac risks.
"Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs," says Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School. "Men should be much more mindful of the possible long-term complications."
MIND Depression Reduced self-confidence Difficulty concentrating Disturbed sleep
BODY Declining muscle and bone mass Increased body fat Fatigue Swollen or tender breasts Flushing or hot flashes
SEXUAL FUNCTION Lower sex drive Fewer spontaneous erections Difficulty sustaining erections
Images: Thinkstock
A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" of testosterone deficiency. "Virtually everybody asks about this now because the direct-to-consumer marketing is so aggressive," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital. "Tons of men who would never have asked me about it before started to do so when they saw ads that say 'Do you feel tired?'"
Just being tired isn't enough to get a testosterone prescription. "General fatigue and malaise is pretty far down my list," Dr. O'Leary says. "But if they have significant symptoms, they'll need to have a lab test. In most men the testosterone level is normal."
If a man's testosterone looks below the normal range, there is a good chance he could end up on hormone supplementsoften indefinitely. "There is a bit of a testosterone trap," Dr. Pallais says. "Men get started on testosterone replacement and they feel better, but then it's hard to come off of it. On treatment, the body stops making testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered."
This wouldn't matter so much if we were sure that long-term hormone therapy is safe, but some experts worry that low-T therapy is exposing men to small risks that could add up to harm over time.
A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.
The evidence for long-term risks is mixed. Some studies have found that men on testosterone have fewer cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. Other studies have found a higher cardiac risk. For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on hormone treatments had noticeably more heart problems. "In older men, theoretical cardiac side effects become a little more immediate," Dr. Pallais says.
Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk.
"Like any treatment, there is risk," Dr. O'Leary says. "I would not give it to a man who is being treated for active prostate cancer, but it's pretty safe under careful supervision for those who need it."
For the time being, the long-term risks of testosterone therapy are "known unknowns." It offers men who feel lousy a chance to feel better, but that quick fix could distract attention from unknown long-term hazards. "I can't tell you for certain that this raises the risk of heart problems and prostate cancer, or that it doesn't," Dr. Pallais says. "We need a large study with multiple thousands of people followed for many years to figure it out."
So, keep risks in mind when considering testosterone therapy. "I frequently discourage it, particularly if the man has borderline levels," Dr. Pallais says.
These steps can help you feel more energetic today without drugs or dietary supplements:
Pace yourself: Spread out activities throughout the day.
Take a walk: It gives you a lift when you feel pooped out.
Snack smart: Have a snack with fiber and some protein between meals.
A large, definitive trial for hormone treatment of men is still to come. Until then, here is how to take a cautious approach to testosterone therapy.
Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.
If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?
If erectile dysfunction has caused you to suspect "low T" as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.
Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone, or the amount of the hormone that is able to have effects on the body. Consider getting a second opinion from an endocrinologist.
After starting therapy, follow-up with your physician periodically to have testosterone checks and other lab tests to make sure the therapy is not causing any problems with your prostate or blood chemistry.
Approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.
Ask your doctor to explain the various side effects for the differentformulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.
Testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with these expectations in mind.
If erectile function has been a problem, testosterone therapy might not fix it. In fact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections.
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Is testosterone therapy safe? Take a breath before you ...
BioTE Medical offers natural testosterone pellets for men and women. Learn more about our products and then Find a Provider to get started today.
Testosterone is a hormone naturally found inside both men and women that is responsible for many different critical body processes. Testosterone is produced in the testes and ovaries. Deficiency occurs as the body ages but suffering from the side effects of this is no longer unavoidable.
BioTE Medical provides bio-identical hormone replacement therapy in the form of pellets. Other forms of testosterone are tablets taken by mouth, tablets placed in the cheek and left to dissolve, muscle injections, patches applied to skin or as a gel. The forms of testosterone that do not release a consistent dosing may provide patients with inconsistent treatment or in the case of patches, short term consistent treatment. Pellets are the only form of testosterone replacement therapy that provides consistent dosing over a period of up to six months. This simple solution to testosterone supplementation has provided lifechanging results for BioTE Medical patients.
BHRT, or bio-identical hormone replacement therapy, uses hormones that most closely represent the ones found in the human body. The term bio-identical refers to how the hormones used in BHRT have a similar molecular structure to the ones found naturally. BHRT uses hormones from plant based sources rather than the animal based sources found in synthetic hormones.
Testosterone pellets are powdered testosterone fused together into a pellet using stearic acid and no chemical binders. The compound pharmacies used provide high-quality pellets, with ingredients that are tested. This testing process gives pharmacists, doctors and patients confidence that only the best pellets are being administered to our patients.
Testosterone pellets are intended to treat a wide range of reproductive, emotional and nonreproductive conditions. Some of these include low energy, chronic exhaustion, sexual dysfunction, mood swings, irritability and many others. How can I get started with testosterone pellet therapy? Do you suffer from any of the conditions listed above? Get started with testosterone pellet therapy by finding your local BioTE Medical provider on our Find a Provider page.
BioTE Medical only offers bio-identical hormone replacement therapy in the form of subcutaneous pellets and with over million insertions performed in the companys history, we have seen many lives changed with optimized hormones. If any of the hormone imbalance symptoms mentioned above ring a bell for you, or remind you of someone you love, BioTE Medical encourages you to use our Find a Provider tool or to nominate your provider to begin your journey to wellness today.
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Testosterone replacement therapy is used to treat patients with hypogonadism, more commonly known as low testosterone (Low T). Testosterone replacement therapy can be used for men or women, but it is primarily used to treat men with low testosterone.
What constitutes low testosterone varies from patient to patient, as do the symptoms of low testosterone.
Testosterone replacement therapy can be used for men or women, but it is primarily used to treat men with low testosterone.
Anyone who is exhibiting the symptoms of low testosterone could possibly benefit from testosterone replacement therapy. Certain medical conditions can cause hypogonadism, which is described as a disease in which your body is unable to produce adequate amounts of testosterone, usually because of an issue that interferes with the normal function of the testicles or with the pituitary gland. Hypogonadism can also be caused by the natural decline of testosterone that occurs in men as they age. Rigorous endurance training can also result in lower testosterone levels. In some men this natural decline of testosterone is well-tolerated, while in others, it results in the symptoms of low testosterone. The symptoms of low testosterone can include:
Just because you are experiencing any, or all, of the signs and symptoms listed above, does not necessarily mean that you have low testosterone. Many of these symptoms can be caused by various other conditions or issues such as: obesity, obstructive sleep apnea, thyroid issues, diabetes, clinical depression, and/or the side effects of certain medications.
The only way to determine if you have low testosterone is to have your blood tested.
Low testosterone could be caused by the natural decline of testosterone that occurs in men as they age. In some men this natural decline of testosterone is well-tolerated, while in others, it results in the symptoms of low testosterone.
Your dosage of testosterone replacement therapy can only be determined after you have received a diagnosis of low testosterone. Low testosterone is determined by a simple blood test. The normal range is 300 ng/dL to 1,000 ng/dL. However, what is normal for one man, can be low for another. This is why testosterone replacement therapy is prescribed on a very individualized basis. Testosterone levels do fluctuate throughout the day they are highest in the morning, so your doctor will probably want to do the blood test in the morning.
If your levels of bio-available testosterone are determined to be low for your weight and age, and if an evaluation of your presenting symptoms warrants it, you will be prescribed with a dosage of testosterone therapy.
The goal of testosterone replacement therapy for adult males, is to prescribe you with the minimal dosage of testosterone that will be sufficient to restore the testosterone level in your blood to normal levels. Dosages of testosterone replacement therapy are titrated, which means that your doctor will start your testosterone replacement at the lowest effective dose. Once treatment is underway, your doctor will closely monitor your symptoms and your testosterone levels, and may need to adjust your dose accordingly.
Testosterone replacement therapy is available as:
Generally speaking, most prescribers of testosterone therapy agree that testosterone injections are the safest and most effective way to give testosterone therapy. Testosterone injections are given into muscles. Testosterone therapy given as intramuscular injections is more easily and rapidly absorbed into the blood stream. Testosterone injections are usually given once every 2 to 4 weeks. Testosterone injections will be given by your healthcare provider, or you will be taught how to self-administer them at home. The total length of time you will have to be on testosterone injections will be determined by your individual symptoms and diagnosis.
Yes. The only way to legally obtain any kind of testosterone replacement therapy is with a doctors prescription. Testosterone is a controlled substance, and cannot be purchased without a prescription. There is no such thing as non-prescription, or over-the-counter (OTC) testosterone. Any product claiming to be testosterone, or contain testosterone that you can purchase online, or anywhere else, without a doctors prescription, is either an ineffective nutritional or amino acid supplement, that does not actually contain any testosterone, or worse yet, is an illegal, unregulated form of testosterone sold on the by black market. In the first case you are probably wasting your time and money, in the second you could be putting your health, or even your life, at risk.
Testosterone therapy may:
Testosterone replacement therapy should not be used by woman who are pregnant or may become pregnant.
You should not receive testosterone replacement therapy if you have been diagnosed with prostate cancer, male breast cancer, a serious heart condition, or severe liver or kidney disease.
Misuse of testosterone replacement therapy can cause serious health complications. Before starting testosterone replacement therapy be sure to tell your doctor if you have:
If you are suffering from the symptoms of low testosterone, and your blood tests reveal that your levels of testosterone are indeed low, there is very little you can do, other than testosterone therapy, to raise them back into the normal range. However, as part of the normal course of testosterone replacement therapy, your doctor may recommended dietary and lifestyle changes, designed to boost and maintain your testosterone level. Such changes could include:
These above lifestyle changes may help but, can only be expected to raise low testosterone levels a limited degree. Testosterone replacement remains as the staple treatment option for correcting low testosterone levels. Informed medical advice remains paramount in you, being proactive & taking control of your health & well being.
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Understanding Testosterone Replacement Therapy
Testosterone Replacement Therapy these words have become more common with every passing year but many still have no clue as to what testosterone replacement therapy really is. Youve seen the commercials for Low-T and if you ask most men they sound great but many still have no clue Low-T is nothing more than testosterone replacement therapy and this therapy unknown to even more is nothing more than a legal prescription for anabolic steroids. Thats right, anabolic steroids; testosterone replacement therapy refers to a treatment in-which low levels of the naturally occurring hormone testosterone are brought back into an adequate range. To perform this function the anabolic steroid testosterone, a synthetic version of the hormone our body produces must be administered.
If you possess any understanding of the performance enhancing world, on its surface the idea of testosterone replacement therapy may bring you a sigh of relief but more than likely it probably irritates you at the same time. After all, for years weve been told anabolic steroids are brewed in the bowels of hell but if you receive testosterone replacement therapy this same hormone from which all anabolic steroids are derived from, now its a welcomed beacon of hope. Yes, you are correct; episodes of the Twilight Zone make far more sense than this confusing conundrum.
Lets from this point on be clear and precise; these advertisements for Low-T treatment and things of this nature are nothing more than advertisements and promotions for anabolic steroids. When you inquire about testosterone replacement therapy understand youre inquiring regarding anabolic steroids; lets call a spade a spade. We are still a long way off from anabolic steroids being generally accepted by the whole of society but it is within testosterone replacement therapy this acceptance holds its most promising form. ,/p>
If you are still unfamiliar with testosterone replacement therapy the idea is very simple. Testosterone replacement therapy is simply providing the body the testosterone it needs in-which it no longer produces naturally. Further, this same therapy is many times provided to increase testosterone levels in men who may not have a decline per say but who naturally do not make enough testosterone. This is where things find themselves a little murky; there isnt a set level of testosterone production that is considered Natural, for the amounts produced vary from person to person. Even so, the idea is sound and very well received by most all men who receive it.
There are those who desire to see testosterone replacement therapy thrown into the trash pile of life; why? We dont have a good specific answer for you because they have yet to give one themselves. Men who receive testosterone replacement therapy enjoy a higher quality of life, they feel better, and they become sick far less often and are generally happier individuals. Why on earth anyone would ever want to legislate testosterone replacement therapy into the ground is beyond reason and comprehension.
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Testosterone Replacement Therapy - SteroidAbuse .com
The Testosterone Replacement Therapy Market is gradually declining and will post a CAGR of (3.35) % during the period 2016-2020.
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Testosterone replacement therapy, also called androgen replacement therapy, is typically used to treat hypogonadism. Testosterone, a hormone produced by the testes, is responsible for the development of secondary sexual characters in men. The levels of testosterone decrease gradually with age, but sometimes this decline is seen even in young men, leading to a condition known as hypogonadism. This can be treated with external supply of testosterone in the form of gels, patches, injectable, or oral drugs.
The Testosterone Replacement Therapy Market research report covers the present scenario and the growth prospects of the Testosterone Replacement Therapy industry for 2016-2020. The Testosterone Replacement Therapy report enlists several important factors, starting from the basics to advanced market intelligence which play a crucial part in strategizing.
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Testosterone Replacement Therapy Market Global Industry ... - satPRnews (press release)
Seen At 11: Testosterone Replacement Therapy Could Come With Serious Side Effects
As CBS 2 #39;s Maurice Dubois reported, doctors say that drugs used to fight low testosterone are not for everyone. Official Site: http://newyork.cbslocal.com/ Y...
By: CBS New York
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Seen At 11: Testosterone Replacement Therapy Could Come With Serious Side Effects - Video
FDA moves towards restricting testosterone replacement
Outtake of the FDA report... Testosterone-replacement therapy is approved "only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause...
By: Dr. Greg Castello
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FDA moves towards restricting testosterone replacement - Video
Being an American, the first thing I worried about when my doctor said I needed to be on TRT (testosterone replacement therapy) for the rest of my life was: How is this going to affect my health insurance costs?
I do have health insurance, but they wont cover testosterone injections unless the doctor gives them to me. Sound familiar? Since I cant afford to take time off work every week to visit my doctors office, Im stuck taking either Testim or Androgel or getting my testosterone by other means.
If I had to do it over again, as I said, Id just contact a mail order compounding pharmacy, get some independent lab tests done, and have a phone consultation with one of their doctors. At least then I wouldnt have a pre-existing condition on my medical records.
The Nuts and Bolts of DIY Testosterone Injections If you think you might need TRT and havent been officially diagnosed as hypogonadal by a doctor yet there is an option that doesnt involve the record-hungry healthcare system: Get the test done privately and pay in cash. You dont need a doctor to read the test results. If youre testosterone is low, contact a compounding pharmacy or hormone replacement / anti-aging clinic that doesnt take health insurance. You can take the shots yourself in the privacy and comfort of your own home; it wont be on your medical records; and you wont end up spending much more than you would with co-pays to the doctor and pharmacy if youd gone the traditional route.
This is a gray area. Testosterone is a schedule III drug and is illegal to obtain without a prescription. The compounding pharmacies and male HRT clinics (also many anti-aging clinics) often have a doctor in-house that will interpret your test results and have a phone consultation with you. That doctor, who you never see in person, will prescribe your testosterone (as well as growth hormone, which is an even grayer area) and any other ancillary drugs (such as Nolvadex or Arimidex to prevent side effects like gynecomastia). They usually dont accept insurance and will ship your HRT drugs out by mail within one week. SO technically, youre getting your drugs from a legal pharmacy, which also happens to have a doctor on staff to provide the prescription. I dont think youd have anything to worry about in court. The HRT or Anti-Aging clinic, on the other hand, might have some legal questions to answer should the DA or DEA ever decide to pay them a visit, which has happened in the past.
Tips on Ordering Testosterone Online If you order testosterone online, follow these tips to stay as close as you can to being legitimate in the eyes of the American court system
Please read this disclaimer: I am not a doctor. I am not an attorney. I am not qualified to dispense legal or medical advice. The information above are only my opinions and should not be taken as legal or medical advice. Always speak to a qualified attorney when you have legal questions. Always see a qualified health professional when you have medical questions.
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Mail Order Testosterone: Legal TRT? - Testosterone ...
Testosterone Replacement, San Diego Anti-Aging Phys George Weiss, MD
Randy Alvarez Interviews Anti-Aging Phys George Weiss, MD, Discussing Testosterone Replacement. http://georgeweissmd.com.
By: The Wellness Hour
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Testosterone Replacement, San Diego Anti-Aging Phys George Weiss, MD - Video
Overview
The good news is that therapy is often very effective. The goals are to restore sexual functioning, increase libido and sense of well-being, prevent osteoporosis by optimizing bone density, restore muscle strength and improve mental functions. Our aim is to bring your levels of serum testosterone back to high normal levels. Beyond this, we aim to normalize other hormones that may be abnormal as well. These include, thyroid hormone, DHEA, estradiol (the main female hormone), and prolactin.
There are a number of ways to treat this condition including transdermal (through the skin) patches and gels, injections, and long-acting slow release pellets. Each modality has its own advantages and disadvantages. Factors include: ability to get good levels, transmissibility to others, frequency and ease of use, and personal preference.
It is important to note that testosterone is not available orally. This is because all drugs absorbed in the stomach go to the liver first. The liver thus gets a very high concentration of the medication. In the case of testosterone, this can increase the chance of liver disease and cancer. This is not the case when it is given by other modalities.
Topical Therapy/Applied to Skin or Mucous Membranes
Testosterone can be applied to the skin or to mucous membranes (the inside of the nose or mouth.) Mixed with the testosterone are specific ingredients that help get it into the bloodstream, and then to the rest of your body. Most often, this is the first line therapy. The range of options and number of branded and generic preparations continues to grow.
Locations
The testosterone may be applied to the:
Advantages/Disadvantages
>Daily Use
Most men start with the topical medications, as they are less intimidating. If for some reason, a man doesnt like it, he just doesnt have to do it the next day.
However, to be effective, all of the topicals must be placed every day. For some men, this is a non-issue. For others this is a burden. They may not be able to remember to put it on consistently. They may not like the way it feels, smells, or tastes.
>Variable Absorption
Many men get good absorption and are able to attain good blood testosterone levels. However, a significant number of men are not able to absorb the medication, and never get good levels.
We always check levels, and switch to a different modality of testosterone replacement, if blood levels are not good enough. In general, we find that if a man is not getting good absorption with one gel or solution, he will not get good levels with a different one. Typically, we will switch to a totally different method.
>Activity Limitations
Since the medications take some time to be absorbed, it is important not to remove them until they have had adequate time to be absorbed.
For the gels and solutions, this is a minimum of two hours. Thus, the user should not shower, swim, or work-out until at least two hours after they have been applied.
For the intranasal (up the nose) gel, which is used three times daily, it is important not to sniff or blow your nose for an hour after use.
>Transmissibility
Though the gels and solutions take a minimum of two hours to be absorbed, they are not completely absorbed at this time. Thus, it is important to shower prior to having skin to skin contact (particularly with women and/or children) to the area where the medication was applied. To avoid transmissibility, you can simply put on a T-shirt.
We usually have our patients apply their once daily medications at night, then sleep with a T-shirt, and shower in the morning, so they are finished with the application for the day.
Most men with pregnant wives or children are not particularly comfortable with using the gels or solutions. There should be no transmissibility issue with the patch or the nasal gel.
>Local Irritation
Since the medication is placed on a particular surface (skin or mucosa) it may cause local irritation.
Local irritation seems to be most common with the patch, where our experience shows that almost no men can tolerate it. Men who are very motivated to use the patch can put a thin layer of hydrocortisone cream over the area first. This often cuts down on the irritation, without decreasing absorption.
For the topical gels and solutions, many men develop rashes or burning. This may be true, even if they rotate the site of application. However, many men have no skin issues whatsoever.
Injections
Testosterone may be injected into the layer of fat underneath the skin (subcutaneously) or into the muscle (intramuscularly- IM), usually the thigh, arm, or buttock. This method has been used by physicians for years, and predates the use of topical testosterone by decades. ( It is also the method that has been most abused by bodybuilders and athletes.)
Traditionally, testosterone was injected only intramuscularly. However, experts have recognized that it is also equally well absorbed when injected into the fat underneath the skin. The needle is much shorter this way, and most men report preferring this technique.
Method
There are various formulations of injectable testosterone. The most common are testosterone cypionate and testosterone enanthate. Testosterone cypionate is the one that virtually all physicians, including us, prescribe.
The dosage is dependent on the individual. In general, we are aiming for men to feel better, which usually correlates to being in the high normal range. We have men injecting as low as 100 mg weekly, and as high as 220 mg weekly. We follow both symptoms and blood work.
Some men notice the ups and downs correlated to the variable levels during the week. These men are then counseled to split the dosage into two, and give themselves two injections per week. This often avoids the peaks and valleys experienced if the medication is given only once during the week.
Many physicians require their patients to come into the office weekly for their injections. This is, of course, burden for many patients. In fact, most patients cannot follow through and drop out of treatment. Other physicians, using the same rationale, give their patients a large dosage on a biweekly or monthly basis. However, this makes the patients have huge peaks and valleys based onhow much is in their system. It also results in more side effects.
The rationale for requiring the patient to come into the office is that this is a restricted drug, and could be abused by the patient. This makes no sense to us for several reasons. The prescribing practitioner knows how much s/he is prescribing. If the patient is running through it much faster than he should be, then there is a problem which is immediately apparent. Also, if a patient wants to abuse steroids, he can just obtain them illegally at many gyms, and doesnt need the physician in the first place. By putting a reasonable and doable treatment plan in place, we feel it is more likely that patients will follow a safe medical regimen.
How is Injectable Testosterone Supplied and How Much Does It Cost?
Testosterone cypionate comes in 10cc and 1cc vials. We strongly recommend our patients get the 10cc vials, as the liquid is very thick (viscous) and it is quite hard to empty the 1cc vials. It is usually more expensive, per cc, to purchase 10 vials of 1cc than it is to purchase 1 vial of 10ccs.
It is available at almost all pharmacies, but sometimes needs to be ordered in advance.
Many drug plans will only pay for one month of medication at a time, which means they will not release a 10cc vial. Fortunately, the medication is relatively inexpensive, and sometimes it is even cheaper to purchase the 10cc vial without using your prescription plan than it is to pay a monthly co-pay and get the 1cc vials. Using a website like goodrx.com or rebates.com, you can make the pharmacies compete for a reasonable price, and a 10cc vial should cost between $35 and $55 (without using your prescription plan).
Thus, for patients without insurance, or with poor drug coverage, the injectable testosterone is by far the cheapest option.
Advantages of injectable testosterone
Disadvantages of injectable testosterone
>Not Bio-identical
Testosterone cypionate is the oil-soluble 17 (beta)- cyclopentylpropionate ester of the androgenic hormone testosterone. In other words, it is not bio-identical testosterone. Men have been making their own testosterone since before we evolved into homo sapiens. But, we have not been making testosterone cypionate. Thus ,there may be some long term side effects of testosterone cypionate that we are not aware of. (Testosterone pellets are an excellent alternative that are bio-identical.)
>Side-Effects
There do seem to be more side effects from testosterone cypionate than from bio-identical testosterone. These include more acne and more increases in hematocrit and estrogen. It is unclear whether this is because there are more peaks and valleys in weekly or biweekly doses than with daily application treatments.
>Self-Injections can be Uncomfortable
Testosterone cypionate is a very thick (viscous) liquid. It is slightly difficult to draw up, and somewhat uncomfortable to inject.
>Compliance
Men do have to remember to give themselves an injection every week, or twice weekly. For some men this is simply not feasible, either because they dread it, or they simply cant remember.
Testosterone Pellets
Testosterone pellets can be inserted in the fat underneath the skin (subcutaneously) once every three months. This is done in the office, and takes less than ten minutes. It has become the most popular method in our practice.
The pellets each contain 75 mg of testosterone. Each pellet is approximately the size of a grain of rice.
In terms of dosing, we can always get good levels of testosterone which we can adjust simply by varying the number of pellets placed, all of which go through the same small skin incision.
How is it Done?
Most of the time, the pellets are placed through a small incision in the skin of the buttock. The incision is so small it is closed with a butterfly bandage (steri-strip). The location is chosen so that it is below the belt line, and above where you sit. No matter how many pellets are placed, only one small skin incision is made.
After the procedure, a butterfly dressing is put on the small nick to hold the edges together, and then a clean dressing. The dressing is waterproof so a man can take a shower with it on. The dressing can be removed after 48 hours. The butterfly dressings then fall off on their own.
We ask our patientsto compress the site and apply ice for a total of 15 minutes, directly after the procedure to limit swelling and bleeding.
Advantages
>Compliance
Men love the fact that they only need to think about this once every three months. Once we have determined the correct dosage, they only need to come to the office once every three months.
>Levels
Unlike the topicals, we can always get men good levels with the pellets.
>Bio-identical
The testosterone pellets are bio-identical. This means that they are exactly what your body makes. Thus, any side effects would only be due to the dosing not to the actual medication itself. In our practice we have a strong preference for bio-identical hormones for this exact reason.
>Cost
Most insurance companies pay for this medication and for the procedure. (However, if they do not, it is much more costly than the testosterone injections.)
Disadvantages
>Discomfort
Some men do not like the procedure. Either they are intimidated by the procedure itself, or they have some post-procedure swelling, bruising, and/or discomfort.
>Infection
Slightly less than 1% of the time, the site can have a small infection. Almost invariably the mans body responds by opening up the tract that the pellets went through and spitting them out. We have never had an abscess or needed to drain the area. We have not needed to give systemic antibiotics.
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Testosterone Replacement Therapy Werner, MD
Indian J Urol. 2014 Jan-Mar; 30(1): 27.
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, Starr 900, New York, NY, USA
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Testosterone replacement therapy (TRT) is a widely used treatment for men with symptomatic hypogonadism. The benefits seen with TRT, such as increased libido and energy level, beneficial effects on bone density, strength and muscle as well as cardioprotective effects, have been well-documented. TRT is contraindicated in men with untreated prostate and breast cancer. Men on TRT should be monitored for side-effects such as polycythemia, peripheral edema, cardiac and hepatic dysfunction.
Keywords: Hypogonadism, side-effects, testosterone replacement therapy
Testosterone has many beneficial effects, including increasing bone strength and density, inducing hematopoiesis, driving sexual function and libido, providing a cardioprotective effect and increasing muscle strength.[1] Testosterone levels are known to decline as men age. The Baltimore Longitudinal Study of Aging reported the incidence of hypogonadism as 20% in men over 60 years of age, 30% in men over 70 years and 50% in men over 80 years of age.[2]
As men age, a decline in testicular production of testosterone are seen, as well as an increase in sex hormone binding globulin, both of which act to decrease bioavailable testosterone.[3] With this gradual decline, the beneficial effects of testosterone could be diminished and negatively affect physical and emotional well-being. Testosterone replacement therapy (TRT) is a reasonable treatment option often discussed for men with low testosterone levels and symptoms of hypogonadism. When replaced, many of the positive effects of testosterone are regained.[4] These positive results have led to a drastic increase in the use of testosterone replacement for men with symptomatic hypogonadism, though long-term data is lacking on the safety.
While the beneficial effects of testosterone are rarely disputed and widely publicized, there is a paucity of the literature on the risks of testosterone use. Any man who has a comorbidity that precludes TRT should be informed of all risks. Factors such as exacerbation of prostate cancer, male breast cancer, worsening benign prostatic hyperplasia (BPH), polycythemia and an increased risk of obstructive sleep apnea (OSA) should be considered when administering TRT to a patient. The goal of this review is to highlight the risks and summarize the current literature on safety of TRT.
One of the major risk factors associated with the administration of testosterone supplementation is its effect on the prostate. We know the prostate to be an androgen-dependent gland and conversely, anti-androgen agents can decrease prostate volume in patients with BPH. As the population continues to age, both the incidence of BPH and late-onset male hypogonadism will continue to rise and practitioners will need to be comfortable with counseling men on the effect of TRT on the prostate.[5]
In a landmark randomized, double-blind, placebo-controlled trial of 44 hypogonadal men, Marks et al. showed that TRT for 6 months improves serum androgen levels, but had little effect on prostate tissue androgen levels, tissue biomarkers and/or gene expression.[6] Testosterone supplementation has been shown to increase prostate size by 12%,[7] but lower urinary tract symptoms (LUTS) and urinary retention do not worsen in men on testosterone therapy.[8,9] Similarly, the presence of hypogonadism in 312 men with reportable LUTS was not predictive of worsening International Prostate Symptom Scores (IPSS) or maximal urinary flow rates.[10]
In fact, some series report an improvement in LUTS after 1 year of TRT.[11,12] In the most recent, randomized controlled trial, 52 men were randomly assigned to receive TRT. At 1 year, the 23 men randomized to 250 mg of testosterone enanthate every 4 weeks reported significant improvements in IPSS and maximal urinary flow rates compared with baseline and controls.[12] At no point in this trial did any patient require additional medication or suffer urinary retention.
While older men on testosterone therapy do have an increase in overall prostate size, this increase in size does not differ from the increase in prostatic hypertrophy seen in elderly men not on testosterone therapy.[13] Taken together, TRT does not appear to grossly worsen LUTS and is not contraindicated in men diagnosed with BPH.
It has been over 60 years since Hodges and Huggins described a relationship between serum testosterone levels and prostate cancer progression.[14] Later in 1982, Fowler and Whitmore reported that exogenous testosterone given to patients with metastatic prostate cancer had worse outcomes.[15] Today androgen deprivation therapy remains a cornerstone of treatment for men with advanced prostate cancer, so it is no surprise that TRT is contraindicated in men with diagnosed prostate cancer, as well as high-risk patients, which includes men with first-degree relatives with prostate cancer and African-Americans who have a prostate-specific antigen (PSA) >3 ng/mL.[4,16]
Recently, there has been a paradigm shift whereby TRT usage has increased despite this potential risk. Many longitudinal studies investigating the relationship of endogenous testosterone levels and subsequent risk of prostate cancer failed to find any association.[17] As such, prostate cancer incidence in men on testosterone therapy is similar to men not on testosterone therapy.[18,19] Similarly, in a 3-year prospective trial, the incidence of prostate cancer was similar among men receiving TRT and controls.[20] In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development.[21] Morgentaler et al. proposed a saturation theory where prostate growth becomes insensitive to changes at normal androgen levels due to saturation of the androgen-receptor; however, there is exponential growth at castrate levels.[22] This theory may explain why testosterone does not directly cause prostate cancer,[23] but it has been shown to accelerate the development of prostate cancer.[24,25]
For premalignancy, prostatic intraepithelial neoplasia (PIN) appears to be a risk factor for developing prostate cancer, however this association has been mostly demonstrated for high-grade disease.[26,27] There is a lack of long-term data on the use of TRT in men with PIN. In one study, 12 months after TRT, only one patient out of 20 men with previous PIN developed overt prostate cancer.[28]
For men who have previously undergone definitive treatment for prostate cancer, the usage of TRT is becoming more accepted. TRT does not appear to increase cancer recurrence in hypogonadal men following radical prostatectomy.[29] In the most recent study by Pastuszak et al., the authors retrospectively reviewed a cohort of 103 men who underwent prior radical prostatectomy and were treated with TRT. Despite a significant increase in PSA in men receiving TRT, there were twice as many cancer recurrences in the control group after 36 months of follow-up.[30]
For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.[31,32] In the most recent study by Morgentaler et al., 13 men with symptomatic hypogonadism and untreated prostate cancer received TRT for a median of 2.5 years and no local prostate cancer progression or distant disease was observed.[33]
While there have been reports of metastatic prostate cancer in older men who are on testosterone therapy,[20] these are mostly anecdotal. Because of this potential risk, practitioners are often reluctant to administer testosterone in patients they believe may be at high risk for prostate cancer or whom they suspect may have the low-grade disease. Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy.[34] Current guidelines on the frequency of PSA monitoring and role of pre-treatment transrectal ultrasound guided prostate biopsy are lacking.[35] Taken together, there has been consistent rejection that TRT causes development of prostate cancer in men, however administration of TRT for hypogonadal men previously treated for high-risk prostate cancer should be taken with caution.
While there is no known physiologic link of testosterone directly to the development of breast cancer, it has been suggested that high levels of testosterone may lead to increased aromatization to an active derivative of estrogen, which ultimately may stimulate breast tissue receptors and increase the risk of male breast cancer.[36]
The role of testosterone in breast cancer development is yet to be fully understood.[37] Currently, several case reports exist[38] and one retrospective review sites an incidence 11% in 45 men on long term TRT over 10 years.[39] Future prospective studies with longer follow-up will determine if such association between TRT and male breast cancer truly exists.
Testosterone leads to an increase in hemoglobin by as much as 5-7%[1,25] through its effect on the production of erythropoietin, which can dramatically improve symptoms of anemia in men.[40,41]
Studies looking at the occurrence of polycythemia as a negative side-effect in men on testosterone therapy are rare. Despite this, polycythemia is an accepted side-effect of TRT. While testosterone exerts a positive effect in men with baseline anemia, it can lead to polycythemia in over 20% of men treated on TRT.[42] Polycythemia may lead to an increased incidence of vascular events, including stroke, myocardial infarction and deep vein thrombosis with possible pulmonary embolus.[42] While these complications are all possible with polycythemia, their theoretical occurrence has not been demonstrated to occur in men on TRT.[43]
Because of this risk of polycythemia, men undergoing TRT should not only have their complete blood count (CBC) monitored during their therapy, but should also have a baseline CBC drawn before testosterone therapy is initiated. While on testosterone therapy, if the hematocrit (HCT) rises greater than 54%, testosterone therapy should be held until the HCT normalizes. If it is restarted after normalization, it should be performed so at a lower dose with continued careful monitoring.[16]
OSA is a risk associated with TRT in men, but its etiology is not particularly well understood. While some studies suggested that there is no association between OSA and TRT,[44] others have demonstrated that that OSA occurs in men undergoing TRT and when supplementation is stopped, the OSA resolves.[45]
While no clear link has been established, men on TRT should be counseled on the risk of potential OSA when therapy is started. They should be monitored for increased symptoms, such as snoring while sleeping or fatigue. If patients starting TRT already carry a diagnosis of OSA, physicians should counsel these patients that TRT may worsen their symptoms. While, OSA remains to be a relative contraindication to initiation of TRT, more research needs to be completed on this association in order to gain a better understanding of its etiology if there is one at all.
The systemic effects of TRT may be exacerbated in men with limited cardiovascular reserve. Previous dogma held that androgens could have atherogenic potential. In a randomized, placebo-controlled trial, Basaria et al. reported an increased risk of cardiovascular events in men randomized to TRT; however, this small cohort had a high prevalence of chronic disease.[46] Today, current literature suggests that TRT has a neutral to beneficial effect on reported cardiovascular events.[47,48] Because some men may have a limited cardiovascular capacity, clinicians prescribing TRT must be cautious with respect to its ability to cause edema.[49] Until date, no longitudinal studies examine the impact of TRT on the cardiovascular system, however some studies suggest that TRT may serve as an adjunct rehabilitative therapy in patients with congestive heart failure (CHF).[50,51,52]
While topical testosterone delivery systems avoid first-pass hepatic metabolism, there remains concern regarding TRT in patients with chronic liver disease. The majority of reports of liver toxicity and jaundice are limited to orally-administered alkylated forms of testosterone.[53] However, a small prospective study representing a cohort of cirrhotic patients demonstrated topical gels to be safe and efficacious.[54] It has also been shown that TRT may improve hepatic function in patients with end-stage liver disease.[55] Because of these mixed results, clinicians should be aware of the possible risks associated with TRT in men with hepatic dysfunction and counsel these men accordingly.
Because TRT is known to cause water retention, caution with testosterone use in patients with chronic renal insufficiency is often advised. In patients with end-stage renal disease (ESRD) on dialysis, fluid shifts are less of a concern in patients on TRT since the fluid retention can be handled with dialysis. While polycythemia may be an adverse side-effect, this is a potential benefit in patients with chronic renal failure and anemia.[56] Furthermore, the half-life of testosterone elimination after withdrawal appears similar between patients with and without ESRD.[56] Few studies have assessed the effects of TRT in patients with chronic kidney disease; however, small studies have suggested that TRT has anabolic effects among ESRD patients, even in the absence of hypogonadism. Aside from frequent monitoring of congestive symptoms and peripheral edema in this select population, TRT appears to be safe for patients with chronic kidney disease without dose adjustment.[57]
When testosterone reaches supra-therapeutic levels, aggressive behavior and increased rates of suicide among adolescent users have been reported;[58] however, no study has documented a negative impact on cognition in men patients receiving TRT. In fact, studies have shown that testosterone replacement to eugonadal levels may improve or stabilize cognitive function.[59,60,61] Lower levels of testosterone have a negative impact on spatial and verbal abilities, as well as cognitive function; therefore, it is no surprise that normalizing testosterone levels results in cognitive improvements.[62,63]
With exogenous testosterone supplementation, the pulsatile release of gonadotropin-releasing hormone is blunted and the release of follicle-stimulating hormone and luteinizing hormone are depressed. As such, a decrease in spermatogenesis is seen.[64] While this effect may not be of importance to many men who have completed their families, physicians prescribing TRT need to be aware.
When serum levels of testosterone are increased, a concurrent increase in the secretion of sebum occurs, which can lead to acne. Despite this known association, this effect is typically minimal.[65] Case reports regarding testosterone supplementation leading to changes in hair patterns have been documented; however no randomized, placebo-controlled trials exist. Various topical and intramuscular injectable forms of testosterone are associated with a variety of skin reactions, mainly erythema and pruritus in up to 60% of users.[20]
TRT is associated with external, physical changes in the men. Exogenous testosterone is known to cause an imbalance in the hypothalamic-pituitary axis. As such, testosterone can be converted to estrogen by aromatization. Excess estrogens may lead to gynecomastia and/or breast pain, both of which may be seen in 10-25% of men on TRT.[66] The ratio of estradiol to androgens is the key factor in the development of gynecomastia rather than absolute increases in androgens themselves.[66] Clinicians must be aware of non-iatrogenic causes of gynecomastia and therefore the appropriate work-up should be sought out to rule out other pathology, especially if there is any breast tenderness or unilateral gynecomastia. Only a few case-reports describe a relationship between male breast cancer and TRT.[38,39]
In addition, excess estrogens may cause an increase in visceral obesity. With vigilant monitoring of serum estrogen levels, TRT has been shown to promote weight loss.[67] Well-known to many prescribers of TRT is a risk of water retention and/or edema. The etiology of this association remains unclear to date.[68] The degree of retention is generally mild. As mentioned above, men on TRT with a history of CHF should follow closely[69].
TRT has numerous benefits that can great enhance a patient's quality-of-life. Before prescribing TRT, one must be conscientious of its adverse effects. Data on the safety of TRT specific to our aging population is not currently available; however TRT has been linked to prostate cancer, BPH, polycythemia and OSA. A full assessment of the morbidity of TRT would require a large-scale, randomized, controlled trial. To date, physicians remain in a quandary about the best approach to care for men with symptoms of hypogonadism. TRT, when given to appropriately selected patients with vigilant monitoring as outlined in this review and in , can bring improvements in quality-of-life, energy level, libido, muscle mass, cognition and bone density.
Potential risks of TRT and associated monitoring strategies
Source of Support: Nil
Conflict of Interest: None declared.
Articles from Indian Journal of Urology : IJU : Journal of the Urological Society of India are provided here courtesy of Medknow Publications
Originally posted here:
Risks of testosterone replacement therapy in men