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Testosterone Replacement Therapy

Critical Update of the 2010 Endocrine Society Clinical Practice Guidelines for Hypogonadism

In 2010, the Endocrine Society published a Clinical Practice Guideline “Testosterone Therapy in Adult Men With Androgen Deficiency Syndromes”, which addressed important issues regarding the diagnosis and treatment of male hypogonadism.[1] 
 
Since publication of this Guideline, several high-quality trials have been conducted, warranting an update of the 2010 recommendations in several areas, especially that of testosterone therapy in men with the metabolic syndrome, type 2 diabetes, sexual dysfunction, and frailty.
 
In addition, many of the previously stated contraindications to testosterone therapy – including severe lower urinary tract symptoms (LUTS) and untreated obstructive sleep apnea (OSA) - have been reexamined in recent trials.
 
Here I summarize the results of a recent systematic analysis of the latest high-quality studies, which call for some important updates of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism.[2] 
 
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Effects of Testosterone Therapy for 3 Years on Subclinical Atherosclerosis Progression in Older Men

Clinical practice guidelines rely heavily on results from randomized controlled trials (RCTs), which is the gold standard for medical research. RCTs produce evidence considered to be of the highest quality. Because RCTs are resource intensive and costly, they are typically of relatively short duration, commonly lasting for around one year. 
 
Currently there are only a few placebo-controlled RCTs investigating the effects of testosterone therapy for a duration of 3 years [1-4], and medical societies have long been urging for more long-term trials evaluating the safety and efficacy of testosterone therapy.[5-7]
 
On August 11th 2015 a notable 3-year long RCT was published in JAMA (Journal of the American Medical Association), which attracted a lot of attention.[8] While interpreted by many as showing that testosterone therapy does not confer any benefits on atherosclerosis, sexual function and quality of life, a closer look at the data actually shows two important positive results…
 
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Normalization of testosterone level is associated with reduced risk of heart attack, stroke and mortality in men

The effect of testosterone replacement therapy on cardiovascular outcomes such as heart attack and stroke are controversial and have been generating heated discussions among clinicians as well as researchers. This, coupled with biased media sensationalism blowing up the supposed “dangers” of testosterone therapy has created great confusion among suffering men, who could gain tremendous health benefits from testosterone therapy.[1]
 
Here I report the results of a new study that examined the relationship between normalization of total testosterone levels with testosterone therapy and cardiovascular events as well as all-cause mortality, in patients without a previous history of heart attack and stroke.[2] This notable study was published in the European Heart Journal on August 6th, 2015.
 
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Long-term testosterone treatment with different testosterone preparations - provocative results on diagnosis and adherence

Due to lack of consistent clear-cut guidelines for diagnosis and treatment of testosterone deficiency, there is a lot of confusion among both health professionals and suffering men. The multiple different testosterone preparations available further add to the complexity of testosterone treatment.

This article presents the intriguing results from a notable study that analyzed effects of testosterone therapy with seven different testosterone preparations in symptomatic men who had previously been denied treatment because of “normal” baseline testosterone levels.[1]
 
The results are quite provocative and highlight several important practical issues relating to diagnosis and treatment of hypogonadism…
 
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Risk of Blood Clots in Men Receiving Testosterone Therapy?

 

 

Venous thromboembolism is a blood clot that forms in a vein deep inside a part of the body; it mainly affects the large veins in the lower leg and thigh. 
 
Blood clot formation (venous thromboembolism) has been suggested to be one main risk with testosterone replacement therapy. In 2014, both the US Food and Drug Administration (FDA) [1] and Health Canada [2] implemented a requirement for manufacturers to add a warning about the potential risks of venous thromboembolism and deep vein thrombosis to the label of all testosterone products.
 
However, until recently there were no comparative studies examining an association between testosterone replacement therapy and venous thromboembolism. Here we report the results of a recent case-control study - published July 20th 2015 - that specifically examined the risk of venous thromboembolism associated with testosterone therapy in middle-aged and older men.[3]
 
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Provocative New Research on Testosterone, Prostate Cancer and BPH/LUTS

The number one concern among clinicians worldwide and reason for not prescribing testosterone is the fear that it will cause prostate cancer and/or worsen benign prostatic hyperplasia (BPH, age-associated prostate gland enlargement that can cause urination difficulty).

This article is a summary of a recent presentation by Dr. Khera at The Annual European Association of Urology (EAU) Congress held in March 2015.
 
The EAU is Europe’s largest annual event for medical health care professionals, showcasing the latest medical research findings in the andrology and urology fields.
 
In this presentation, Dr. Khera debunks the popular widespread myth that testosterone supposedly is harmful for the prostate, and presents provocative new testosterone research…
 
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Testosterone Replacement Therapy and Hormonophobia – Cardiovascular risk, the Media, and the Authorities

One of the most controversial and debated issue related to testosterone replacement therapy is its effects on cardiovascular risk and related clinical outcomes.
 
In this video presentation, Dr. Morgentaler clarifies misperceptions of testosterone replacement therapy and cardiovascular disease risk, which have created unwarranted concerns and distorted public discussion of testosterone replacement therapy as a medical treatment.
 
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Video Summary of Testosterone Replacement Therapy and Cardiovascular Risk

One of the most controversial and debated issue related to testosterone replacement therapy is its effects on cardiovascular risk and related clinical outcomes.
 
In the February 2015 issue of Mayo Clinic Proceedings a comprehensive medical review paper, written by Dr. Abraham Morgentaler and his coauthors of the Androgen Study Group – www.AndrogenStudyGroup.org - was published.[1]
 
The aim of the review was to analyze all available studies on testosterone replacement therapy and cardiovascular effects, and to clarify the grossly misleading conclusions from two recent studies that caused a tremendous media scare.
 
In this 8 minute video, Dr. Morgentaler presents the key results from this comprehensive analysis…
 
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Testosterone Therapy and Cardiovascular Risk - Advances and Controversies

One of the most debated issues related to testosterone therapy is its effects on cardiovascular risk and clinical events, like for example heart attack.
 
January 27th, 2015 a comprehensive medical review paper was published, addressing the controversial topic of testosterone therapy and cardiovascular risk.[65] It was written by the Androgen Study Group academicians and published in Mayo Clinic Proceedings.
 
Here I summarizes key conclusions from this milestone medical review.
 
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Dr. Pierce's Medical Organization Affiliations

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