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Testosterone Replacement Therapy

Testosterone Replacement Therapy

Testosterone Deficiency - Prevalence and Treatment Rates

Testosterone deficiency, also known as hypogonadism, is gaining recognition among both clinicians and the general population. This article summarizes the findings from a review on the prevalence of testosterone deficiency, as well as the proportion of hypogonadal men who are receiving testosterone treatment.[1]
 
While testosterone prescribing has increased lately, as you will find out here, the prevalence of testosterone deficiency far exceeds the prescribing rate; i.e. majority of men with low-T are still not being treated with testosterone therapy.
 
You may be surprised to find out that testosterone deficiency is still not well-understood by general practitioners and cardiologists, and that these key clinicians lack knowledge on its deleterious cardiovascular effects. Therefore, even man needs to take control of his own health and don't let any ignorant or old-school doctor deny you a prescription that you may need...
 
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Testosterone Treatment and Heart Attack Risk - new study shows testosterone treatment can even be beneficial

Testosterone therapy has been in use for more than 70 years for the treatment of testosterone deficiency, historically called hypogonadism.[1]In the past 30 years there has been a growing body of scientific research demonstrating that testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality [2, 3]. In line with the detrimental health outcomes seen with testosterone deficiency, testosterone therapy has been shown to confer beneficial effects on multiple risk factors and risk biomarkers related to these clinical conditions.[4]
 
Despite these well-documented health benefits, testosterone therapy is still controversial, in large part due to a few flawed studies and media outcry about potential elevated heart attack risk with testosterone therapy. On July 2, 2014, a study was published which demonstrated that testosterone therapy is not associated with an increased risk of MI, and that is actually may protect against heart attack....[5]
 
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Multiple beneficial effects of testosterone replacement therapy in men with testosterone deficiency

Alleged concerns regarding risk of cardiovascular disease with testosterone replacement therapy (TRT) have been promulgated recently. However, a large and growing number of intervention studies show to the contrary that TRT reduces cardiovascular risk factors and confers multiple beneficial health effects. Thus, fears promoted by some recent flawed studies need to be critically re-evaluated. 
 
This article gives an overview of studies that have investigated health effects and safety of TRT.[1] As outlined here, the position that testosterone deficiency (TD) should be regarded as a risk factor for cardiovascular disease is supported by a rapidly expanding body of evidence.[2-4]
 
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How Is Testosterone Deficiency "Low-T" Diagnosed? - Things you need to know before going to your doctor

Testosterone deficiency, popularly known as "low T", has entered the center stage in both the lay and medical communities. However, how is testosterone deficiency (a.k.a. hypogonadism) diagnosed? What is the testosterone level threshold below which you can say you have low T? What are the references ranges for healthy men? 
 
Here you will find out what the medical guidelines say, what critical information they are ignoring, what you should point out to your doctor if he/she doesn't think you have low T...
 
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Testosterone and Prostate Cancer - Bye Androgen Hypothesis, Welcome Saturation Model

 

A long-held belief is that testosterone stimulates development of prostate cancer and/or accelerates its growth. This fear is the most common reason for doctors' reluctance to prescribe testosterone replacement therapy, even in hypogonadal men [1, 2] , which unnecessarily deprives many hypogonadal men of clinical benefits.
 
This summary gives an overview of an in-depth review of current literature regarding the relationship of testosterone levels and prostate cancer, and the effect of testosterone replacement therapy on prostate cancer progression and recurrence.[3] Key studies which have refuted the old belief that testosterone has harmful effects on the prostate are presented, along the new testosterone-prostate paradigm known as the saturation model.
 
Surprisingly, new research provocatively suggests that it is not high testosterone levels that are problematic for prostate cancer, but to the contrary that it is low serum T that is associated with worrisome cancer features and outcomes...and new experimental research has uncovered mechanisms that explain how low testosterone levels may be detrimental for prostate health, and support the new view that testosterone therapy actually may have beneficial effects with regard to prostate cancer...
 
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The Androgen Study Group - Cutting Through Misleading Headlines and Exposing the Truth about Testosterone Therapy and Health

Recently several flawed studies, implicating that testosterone replacement therapy increases risk for heart attack and death, created large media headlines. This despite a large body of research evidence showing the contrary, ie. that testosterone replacement therapy decreases risk for heart disease and that higher testosterone levels are associated with reduced death rates. No wonder there is confusion and unnecessary concern and among healthcare providers and their patients.
 
In response to this, The Androgen Study Group was formed. The Androgen Study Group is a multidisciplinary group of androgen researchers and clinicians who are dedicated to education and accurate reporting on the science of testosterone deficiency in men and its treatment. With the media attention that testosterone therapy is attracting it is critical that clinical trials are properly conducted and analyzed, and that results are presented in a way that is not misleading. The mission of the Androgen Study Group is to ensure that the results of research on testosterone deficiency and its treatment is presented accurately and fairly in the medical literature as well as in public media.
 
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Muscle function and lean body mass during testosterone therapy combined with strength training and in aging men

Study shows only a combination of testosterone therapy and strength training results in an increase in both mechanical muscle function and muscle mass (LBM).

OBJECTIVES:

To examine the effect of strength training and testosterone therapy on mechanical muscle function and lean body mass (LBM) in aging men with low-normal testosterone levels in a randomized, double-blind, placebo controlled 24-week study.

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Effects of 6-year Long-Term Testosterone Replacement Therapy (TRT) in Patients with ‘‘Diabesity’’

March 6th 2014 FDA approved Aveed for treatment of male hypogonadism, aka testosterone deficiency.[1] Aveed is a long-acting form of injectable testosterone called testosterone undecanoate. In Europe, testosterone undecanoate (under the name Nebido) has a long successful TRT track record for treatment of testosterone deficiency and its consequences (especially obesity, the metabolic syndrome and diabetes).[2-16]

In contrast to shorter acting forms of testosterone (e.g. cypionate), testosterone undecanoate only needs to be injected every 6 to 12 weeks, and thereby offers practical benefits to patients. (Comment: for Nebido (1000 mg per 4 ml) the initial interval is 6 weeks, followed by intervals of 10-14 weeks; for Aveed (750 mg per 3 ml) the initial interval is 4 weeks, followed by 10-week intervals). 

Five days after the FDA approval a notable and impressive 6-year long TRT study was published, confirming the health benefits of TRT that have previously been found in shorter term studies... [44]

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Testosterone Replacement Therapy (TRT) - does it really increase risk of heart attack? Commentaries from medical organizations

We previously posted a commentary on the recently published and notoriously flawed study which concluded that TRT increases risk for heart attack.

Does Testosterone Therapy Really Increase the Risk of Heart Attack?

http://www.agelessforever.net/anti-aging-news-articles/entry/does-testosterone-therapy-really-increase-the-risk-of-heart-attack

This is the study which caused the media debates:

January 29th issue, the Scientific Journal PLOS (Public Library of Science) ONE published the article: 

"Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men."

Here we have gathered commentaries from other medical professionals, all in one place:

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Testosterone Replacement Therapy (TRT) in Testosterone Deficient men - effects on fat loss, waist reduction and metabolic syndrome components

Testosterone deficiency in men, aka hypogonadism, is associated with increased total and abdominal fat mass, and reduced muscle mass, which negatively impacts body composition.[1, 2] This contributes to development of risk factors like insulin resistance, chronic inflammation, and atherogenic dyslipidemia (a triad of increased blood levels of small, dense LDL particles and triglycerides, and decreased levels of HDL particles), which increase the risk for cardiovascular disease, metabolic syndrome and diabetes.[1, 3-16]

Previous studies have shown that testosterone replacement therapy ameliorates these risk factors in testosterone deficient (hypogonadal) men; it increases insulin sensitivity [17-20] and HDL (the "good" cholesterol) [9, 10, 20, 21], and reduces waist circumference [9, 20, 22], fasting blood glucose [9, 20] triglycerides (blood fats)[9], LDL (the "bad" cholesterol) [19, 22-24], and several inflammatory markers.[17, 25]

A 2011 meta-analysis concluded that testosterone replacement therapy improves metabolic control, as well as reduces abdominal obesity.[9] Many studies have shown that testosterone replacement therapy in hypogonadal men increases muscle mass and reduces fat mass.[19, 26-32] Further, adding testosterone (50 mg/day for 1 year, administered as a transdermal gel) to a diet and exercise program results in greater therapeutic improvements of glycemic control and reverses the metabolic syndrome.[20]

Testosterone also has direct (non-obesity mediated) beneficial effects on many metabolic and cardiovascular risk factors [12, 33-37], and reduces death risk independently of body fat status.[38] In line with all these effects, low testosterone levels are associated with increased risk of cardiovascular complications [39], and all-cause and cardiovascular disease death [40-42]. Low testosterone may thus be a predictive marker for men at high risk of cardiovascular disease.[41] In a group of men aged 50-91 who were followed for 20 years, it was found that men whose total testosterone levels were in the lowest quartile (241 ng/dl or lower) were 40% more likely to die than those with higher levels, independent of age, adiposity, lifestyle or presence of cardiovascular risk factors.[38]

Thus, treatment of testosterone deficient men with testosterone has demonstrated considerable health benefits. Despite this, critics state that most of the studies on testosterone replacement therapy were too small. They also argue that the studies were of too short duration (most of them lasting 6-12 months), and that the long-term effects of testosterone on body composition are not known.

Two 5 year long studies were just published that addressed the duration and small study size shortcomings in previous research...

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