Androgen replacement therapy explained

Androgen replacement therapy -->
Synonyms:Testosterone replacement therapy

Androgen replacement therapy (ART), often referred to as testosterone replacement therapy (TRT), is a form of hormone therapy in which androgens, often testosterone, are supplemented or replaced. It typically involves the administration of testosterone through injections, skin creams, patches, gels, pills, or subcutaneous pellets. ART is often prescribed to counter the effects of male hypogonadism.

ART is also prescribed to lessen the effects or delay the onset of normal male aging. However, this is controversial and is the subject of ongoing clinical trials.[1] [2] [3] [4] [5] [6] [7]

As men enter middle age they may notice changes caused by a relative decline in testosterone: fewer erections, fatigue, thinning skin, declining muscle mass and strength, and/or more body fat. Dissatisfaction with these changes causes some middle age men to seek ART. Androgen deficiencies in women have also, as of 2001, been recognized as a medical disorder that can be treated with ART.[8] As with men, symptoms associated with androgen deficiency are most prevalent with age, and androgen replacement therapy has been shown to help with symptoms of menopause.[9]

Medical uses

See also: Testosterone (medication).

Males

Androgen replacement is the classic treatment of hypogonadism.[10] It is also used in men who have lost the ability to produce androgens due to disease or its treatment.[11] [12]

Diabetes

The risks of diabetes and of testosterone deficiency in men over 45 (i.e., hypogonadism, specifically hypoandrogenism) are strongly correlated. Testosterone replacement therapies have been shown to improve blood glucose management.[13] [14] Still, "it is prudent not to start testosterone therapy in men with diabetes solely for the purpose of improving metabolic control if they show no signs and symptoms of hypogonadism."[15]

Females

Androgen replacement is used in postmenopausal women: the indications are to increase sexual desire; and to prevent or treat osteoporosis.[16] Other symptoms of androgen deficiency are similar in both sexes, such as muscle loss and physical fatigue.[8] The androgens used for androgen replacement in women include testosterone (and esters), prasterone (dehydroepiandrosterone; DHEA) (and the ester prasterone enanthate), methyltestosterone, nandrolone decanoate, and tibolone, among others.[16]

Adverse effects

The Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging.[17] The FDA has required that testosterone labels include warning information about the possibility of an increased risk of heart attacks and stroke.[17]

Heart disease

On January 31, 2014, reports of strokes, heart attacks, and deaths in men taking testosterone-replacement led the FDA to announce that it would be investigating this issue. The FDA's action followed three peer-reviewed studies of increased cardiovascular events and deaths.[18] Due to an increased rate of adverse cardiovascular events compared to a placebo group, a randomized trial stopped early.[19] Also, in November 2013, a study reported an increase in deaths and heart attacks in older men.[20] Concerns have been raised that testosterone was being widely marketed without the benefit of data on efficacy and safety from large randomized controlled trials.[21] As a result of the "potential for adverse cardiovascular outcomes", the FDA announced, in September 2014, a review of the appropriateness and safety of testosterone replacement therapy.[22] [23] [24] However, when given to men with hypogonadism in the short- and medium-term, testosterone replacement therapy does not increase the risk of cardiovascular events (including strokes and heart attacks and other heart diseases). The long-term safety of the therapy is not known yet.[25] [26]

Other

Other significant adverse effects of testosterone supplementation include acceleration of pre-existing prostate cancer growth in individuals who have undergone androgen deprivation; increased hematocrit, which can require venipuncture in order to treat; and, exacerbation of sleep apnea.[27] A 2014 review said there was some evidence men with certain comorbidities may be at risk of adverse effects including sleep apnoea, metabolic syndrome and cardiovascular disease.[28] Exogenous testosterone may also cause suppression of spermatogenesis, leading to, in some cases, infertility.[29] It is recommended that physicians screen for prostate cancer with a digital rectal exam and prostate-specific antigen (PSA) level before starting therapy, and monitor PSA and hematocrit levels closely during therapy.[30]

Some studies argue that ART increases the risk of prostate cancer, although the results are not conclusive.[31]

Methods of administration

There are several artificial androgens, many of which are manipulations of the testosterone molecule referred to as anabolic-androgenic steroids. Androgen replacement is administered by patch, tablet, capsule, cream or gel; or depot injections given into fat or muscle.[32]

Society and culture

MMA

Some UFC fighters used TRT until 2014 when the Nevada State Athletic Commission banned its use.[33]

Regulation

As of September 2014, testosterone replacement therapy has been under review for appropriateness and safety by the Food and Drug Administration due to the "potential for adverse cardiovascular outcomes".

Frequency of use

In the United States usage increased from 0.5% in 2002 to 3.2% in 2013 and have since decreased to 1.7% in 2016.[34]

A UK study in 2013 showed that prescriptions for testosterone replacement, particularly transdermal products, almost doubled between 2000 and 2010.[35]

Research

Testosterone is being investigated as therapy for the following conditions:

See also

Notes and References

  1. Web site: 2012 . Testosterone therapy: Key to male vitality? . Mayo Foundation for Medical Education and Research (MFMER) .
  2. Sood A, Hosseinpour A, Sood A, Avula S, Durrani J, Bhatia V, Gupta R . Cardiovascular Outcomes of Hypogonadal Men Receiving Testosterone Replacement Therapy: A Meta-analysis of Randomized Controlled Trials . Endocrine Practice . 30. 1. October 2023 . 2–10 . 37797887 . 10.1016/j.eprac.2023.09.012 . 263692728 .
  3. Valderrábano RJ, Pencina K, Storer TW, Reid KF, Kibel AS, Burnett AL, Huang G, Dorff T, Privat F, Ghattas-Puylara C, Wilson L, Latham NK, Holmberg M, Bhasin S . 6 . Testosterone replacement in prostate cancer survivors with testosterone deficiency: Study protocol of a randomized controlled trial . Andrology . 11 . 1 . 93–102 . January 2023 . 36181480 . 10.1111/andr.13299 . 9771994 .
  4. Pencina KM, Travison TG, Artz AS, Lincoff AM, Nissen SE, Flevaris P, Chan A, Li X, Diegel SA, Wannemuehler K, Bhasin S . 6 . Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism: A Randomized Clinical Trial . JAMA Network Open . 6 . 10 . e2340030 . October 2023 . 37889486 . 10611996 . 10.1001/jamanetworkopen.2023.40030 .
  5. Christensen LL, Poulsen HE, Andersen MS, Glintborg D . Whole-body oxidative stress reduction during testosterone therapy in aging men: A randomized placebo-controlled trial . Andrology . 12 . 1 . 115–122 . January 2024 . 37177884 . 10.1111/andr.13458 . free .
  6. Diaz P, Reddy R, Blachman-Braun R, Zucker I, Dullea A, Gonzalez DC, Kresch E, Ramasamy R . 6 . Comparison of Intratesticular Testosterone between Men Receiving Nasal, Intramuscular, and Subcutaneous Pellet Testosterone Therapy: Evaluation of Data from Two Single-Center Randomized Clinical Trials . The World Journal of Men's Health . 41 . 2 . 390–395 . April 2023 . 35791295 . 10042650 . 10.5534/wjmh.210261 .
  7. Corona G, Torres LO, Maggi M . Testosterone Therapy: What We Have Learned From Trials . The Journal of Sexual Medicine . 17 . 3 . 447–460 . March 2020 . 31928918 . 10.1016/j.jsxm.2019.11.270 . 210191244 . 2158/1192573 . free .
  8. Bachmann G, Bancroft J, Braunstein G, Burger H, Davis S, Dennerstein L, Goldstein I, Guay A, Leiblum S, Lobo R, Notelovitz M, Rosen R, Sarrel P, Sherwin B, Simon J, Simpson E, Shifren J, Spark R, Traish A . 6 . Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment . Fertility and Sterility . 77 . 4 . 660–665 . April 2002 . 11937111 . 10.1016/S0015-0282(02)02969-2 . free .
  9. Sarrel PM . Androgen deficiency: menopause and estrogen-related factors . Fertility and Sterility . 77 . S63–S67 . April 2002 . Suppl 4 . 12007905 . 10.1016/S0015-0282(02)02967-9 .
  10. Kang DY, Li HJ . The effect of testosterone replacement therapy on prostate-specific antigen (PSA) levels in men being treated for hypogonadism: a systematic review and meta-analysis . Medicine . 94 . 3 . e410 . January 2015 . 25621688 . 4602637 . 10.1097/MD.0000000000000410 .
  11. Giwercman A, Lundberg Giwercman Y . Hypogonadism in young men treated for cancer . Hormones . 14 . 4 . 590–597 . 2015 . 26859600 . 10.14310/horm.2002.1650 . free .
  12. Ukwenya VO . Testosterone propionate ameliorates oxidatve stress and inflammation in nicotine-induced testicular toxicity.. Journal of Experimental and Clinical Anatomy. 2019. 18. 1. 74–78. 10.4103/jeca.jeca_10_19. March 10, 2024 . 208531742 . free .
  13. Morales A, Bella AJ, Chun S, Lee J, Assimakopoulos P, Bebb R, Gottesman I, Alarie P, Dugré H, Elliott S . 6 . A practical guide to diagnosis, management and treatment of testosterone deficiency for Canadian physicians . Canadian Urological Association Journal . 4 . 4 . 269–275 . August 2010 . 20694106 . 2910774 . 10.5489/cuaj.880 .
  14. Morimoto S, Jiménez-Trejo F, Cerbón M . Sex steroids effects in normal endocrine pancreatic function and diabetes . Current Topics in Medicinal Chemistry . 11 . 13 . 1728–1735 . 2011 . 21463250 . 10.2174/156802611796117540 .
  15. Basaria S . Male hypogonadism . Lancet . 383 . 9924 . 1250–1263 . April 2014 . 24119423 . 10.1016/S0140-6736(13)61126-5 . 30479724 .
  16. Davis SR . The therapeutic use of androgens in women . The Journal of Steroid Biochemistry and Molecular Biology . 69 . 1–6 . 177–184 . 1999 . 10418991 . 10.1016/S0960-0760(99)00054-0 . 23520067 .
  17. Web site: Staff . Testosterone Products: Drug Safety Communication - FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke . March 3, 2015 . . March 5, 2015 .
  18. Finkle WD, Greenland S, Ridgeway GK, Adams JL, Frasco MA, Cook MB, Fraumeni JF, Hoover RN . 6 . Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men . PLOS ONE . 9 . 1 . e85805 . January 2014 . 24489673 . 3905977 . 10.1371/journal.pone.0085805 . free . 2014PLoSO...985805F .
  19. Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, Eder R, Tennstedt S, Ulloor J, Zhang A, Choong K, Lakshman KM, Mazer NA, Miciek R, Krasnoff J, Elmi A, Knapp PE, Brooks B, Appleman E, Aggarwal S, Bhasin G, Hede-Brierley L, Bhatia A, Collins L, LeBrasseur N, Fiore LD, Bhasin S . 6 . Adverse events associated with testosterone administration . The New England Journal of Medicine . 363 . 2 . 109–122 . July 2010 . 20592293 . 3440621 . 10.1056/NEJMoa1000485 .
  20. Vigen R, O'Donnell CI, Barón AE, Grunwald GK, Maddox TM, Bradley SM, Barqawi A, Woning G, Wierman ME, Plomondon ME, Rumsfeld JS, Ho PM . 6 . Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels . JAMA . 310 . 17 . 1829–1836 . November 2013 . 24193080 . 10.1001/jama.2013.280386 .
  21. Web site: McCullough M . As testosterone use grows, questions on risks await answers . April 4, 2014 . . March 19, 2015 .
  22. News: Tavernise S . F.D.A. Panel Backs Limits on Testosterone Drugs . September 17, 2014 . . September 18, 2014 .
  23. News: Staff . FDA Panel To Review Testosterone Therapy Appropriateness and Safety . September 5, 2014 . . September 14, 2014 . https://web.archive.org/web/20160304062101/http://ireport.cnn.com/docs/DOC-1167887 . March 4, 2016 . dead .
  24. Web site: Staff . Joint Meeting for Bone, Reproductive and Urologic Drugs Advisory Committee (BRUDAC) and the Drug Safety And Risk Management Advisory Committee (DSARM AC) - FDA background documents for the discussion of two major issues in testosterone replacement therapy (TRT): 1. The appropriate indicated population for TRT, and 2. The potential for adverse cardiovascular outcomes associated with use of TRT . September 17, 2014 . . September 14, 2014 .
  25. 6 February 2023 . Research provides reassurance about the safety of testosterone treatment . NIHR Evidence . Plain English summary . National Institute for Health and Care Research. 10.3310/nihrevidence_56696 . 257851823 .
  26. Hudson J, Cruickshank M, Quinton R, Aucott L, Aceves-Martins M, Gillies K, Bhasin S, Snyder PJ, Ellenberg SS, Grossmann M, Travison TG, Gianatti EJ, van der Schouw YT, Emmelot-Vonk MH, Giltay EJ, Hackett G, Ramachandran S, Svartberg J, Hildreth KL, Groti Antonic K, Brock GB, Tenover JL, Tan HM, Kong CH, Tan WS, Marks LS, Ross RJ, Schwartz RS, Manson P, Roberts S, Andersen MS, Magnussen LV, Hernández R, Oliver N, Wu F, Dhillo WS, Bhattacharya S, Brazzelli M, Jayasena CN . 6 . Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis . The Lancet. Healthy Longevity . 3 . 6 . e381–e393 . June 2022 . 35711614 . 9184259 . 10.1016/S2666-7568(22)00096-4 .
  27. Pastuszak AW, Pearlman AM, Lai WS, Godoy G, Sathyamoorthy K, Liu JS, Miles BJ, Lipshultz LI, Khera M . 6 . Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy . The Journal of Urology . 190 . 2 . 639–644 . August 2013 . 23395803 . 4544840 . 10.1016/j.juro.2013.02.002 .
  28. Grech A, Breck J, Heidelbaugh J . Adverse effects of testosterone replacement therapy: an update on the evidence and controversy . Therapeutic Advances in Drug Safety . 5 . 5 . 190–200 . October 2014 . 25360240 . 4212439 . 10.1177/2042098614548680 .
  29. Contraceptive efficacy of testosterone-induced azoospermia in normal men. World Health Organization Task Force on methods for the regulation of male fertility . Lancet . 336 . 8721 . 955–959 . October 1990 . 1977002 . 10.1016/0140-6736(90)92416-F . 25825354 .
  30. Book: Liverman CT, Blazer DG . Washington (DC) . Introduction - Testosterone and Aging . Introduction . NCBI Bookshelf . National Academies Press (US) . 2004 .
  31. Barqawi A, Crawford ED . Testosterone replacement therapy and the risk of prostate cancer. Is there a link? . International Journal of Impotence Research . 18 . 4 . 323–8 . 2006 . 16281043 . 10.1038/sj.ijir.3901418 . 46230482 .
  32. Web site: Staff . FDA evaluating risk of stroke, heart attack and death with FDA-approved testosterone products . . January 31, 2014 . September 17, 2014 .
  33. Web site: Nevada commission bans testosterone replacement . AP News . 27 February 2014.
  34. Baillargeon J, Kuo YF, Westra JR, Urban RJ, Goodwin JS . Testosterone Prescribing in the United States, 2002-2016 . JAMA . 320 . 2 . 200–202 . July 2018 . 29998328 . 6396809 . 10.1001/jama.2018.7999 .
  35. Gan EH, Pattman S, Pearce HS, Quinton R . A UK epidemic of testosterone prescribing, 2001-2010 . Clinical Endocrinology . 79 . 4 . 564–570 . October 2013 . 23480258 . 10.1111/cen.12178 . 4952458 .
  36. Walther A, Mahler F, Debelak R, Ehlert U . Psychobiological Protective Factors Modifying the Association Between Age and Sexual Health in Men: Findings From the Men's Health 40+ Study . American Journal of Men's Health . 11 . 3 . 737–747 . May 2017 . 28413941 . 5675228 . 10.1177/1557988316689238 .
  37. Finkelstein JS, Lee H, Leder BZ, Burnett-Bowie SA, Goldstein DW, Hahn CW, Hirsch SC, Linker A, Perros N, Servais AB, Taylor AP, Webb ML, Youngner JM, Yu EW . 6 . Gonadal steroid-dependent effects on bone turnover and bone mineral density in men . The Journal of Clinical Investigation . 126 . 3 . 1114–1125 . March 2016 . 26901812 . 4767351 . 10.1172/JCI84137 .
  38. Farley JF, Blalock SJ . Trends and determinants of prescription medication use for treatment of osteoporosis . American Journal of Health-System Pharmacy . 66 . 13 . 1191–1201 . July 2009 . 19535658 . 10.2146/ajhp080248 .
  39. Traish AM, Saad F, Guay A . The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance . Journal of Andrology . 30 . 1 . 23–32 . 2009 . 18772488 . 10.2164/jandrol.108.005751 . 29463129 .
  40. Boyanov MA, Boneva Z, Christov VG . Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency . The Aging Male . 6 . 1 . 1–7 . March 2003 . 12809074 . 10.1080/tam.6.1.1.7 . 7328751 . free .
  41. Caminiti G, Volterrani M, Iellamo F, Marazzi G, Massaro R, Miceli M, Mammi C, Piepoli M, Fini M, Rosano GM . 6 . Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and baroreflex sensitivity in elderly patients with chronic heart failure a double-blind, placebo-controlled, randomized study . Journal of the American College of Cardiology . 54 . 10 . 919–927 . September 2009 . 19712802 . 10.1016/j.jacc.2009.04.078 . free .
  42. Cherrier M . Testosterone effects on cognition in health and disease . Frontiers of Hormone Research . 37 . 150–162 . 2009 . 19011295 . 10.1159/000176051 . 978-3-8055-8622-1 .

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Androgen replacement therapy".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.