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Traish AM, Zitzmann M. The complex and multifactorial relationship between testosterone deficiency (TD), obesity and vascular disease. Rev Endocr Metab Disord 2015; 16:249-68. [PMID: 26590935 DOI: 10.1007/s11154-015-9323-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Testosterone deficiency (TD) is a well-established and recognized medical condition that contributes to several co-morbidities, including metabolic syndrome, visceral obesity and cardiovascular disease (CVD). More importantly, obesity is thought to contribute to TD. This complex bidirectional interplay between TD and obesity promotes a vicious cycle, which further contributes to the adverse effects of TD and obesity and may increase the risk of CVD. Testosterone (T) therapy for men with TD has been shown to be safe and effective in ameliorating the components of the metabolic syndrome (Met S) and in contributiong to increased lean body mass and reduced fat mass and therefore contributes to weight loss. We believe that appropriate T therapy in obese men with TD is a novel medical approach to manage obesity in men with TD. Indeed, other measures of lifestyle and behavioral changes can be used to augment but not fully replace this effective therapeutic approach. It should be noted that concerns regarding the safety of T therapy remain widely unsubstantiated and considerable evidence exists supporting the benefits of T therapy. Thus, it is paramount that clinicians managing obese men with TD be made aware of this novel approach to treatment of obesity. In this review, we discuss the relationship between TD and obesity and highlight the contemporary advancement in management of obesity with pharmacological and surgical approaches, as well as utilization of T therapy and how this intervention may evolve as a novel approach to treatment of obesity in men with TD .
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, 72 Concord Street, A502, Boston, MA, 02118, USA.
| | - Michael Zitzmann
- Clinical Andrology, Centre for Reproductive Medicine and Andrology, Domagkstrasse 11, D-48149, Muenster, Germany
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Saad F, Yassin A, Doros G, Haider A. Effects of long-term treatment with testosterone on weight and waist size in 411 hypogonadal men with obesity classes I-III: observational data from two registry studies. Int J Obes (Lond) 2015. [PMID: 26219417 PMCID: PMC4722240 DOI: 10.1038/ijo.2015.139] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Long-term testosterone replacement therapy (TRT) up to 5 years has been shown to produce progressive and sustainable weight loss (WL) in hypogonadal men. This study investigated effects of long-term TRT up to 8 years in hypogonadal men with different obesity classes. SUBJECTS/METHODS From two independent observational registries we identified a total of 411 obese, hypogonadal men receiving TRT in urological clinics. The effects of TRT on anthropometric as well as metabolic parameters were studied for a maximum duration of 8 years, mean follow-up: 6 years. All men received long-acting injections of testosterone undecanoate in 3-monthly intervals. RESULTS In all three classes of obesity, T therapy produced significant WL, decrease in waist circumference (WC) and body mass index (BMI). In patients with class I obesity, mean weight decreased from 102.6±6.4 to 84.1±4.9 kg, change from baseline: -17.4±0.5 kg and -16.8±0.4%. WC in this group of patients decreased from 106.8±7.4 to 95.1±5.3 cm, change from baseline: -10.6±0.3 cm. BMI decreased from 32.69±1.4 to 27.07±1.57, change from baseline: -5.52±0.15 kg m(-2). In patients with class II obesity, weight decreased from 116.8±6.9 to 91.3±6.3 kg, change from baseline: -25.3±0.5 kg and -21.5±0.4%. WC decreased from 113.5±7.5 to 100.0±5.4 cm, change from baseline: -13.9±0.4 cm. BMI decreased from 37.32±1.45 to 29.49±1.71, change from baseline: -8.15±0.17 kg m(-2). In patients with class III obesity, weight decreased from 129.0±5.6 to 98.9±4.8 kg, change from baseline: -30.5±0.7 kg and -23.6±0.5%. WC decreased from 118.5±5.6 to 103.8±4.9 cm, change from baseline: -14.3±0.4 cm. BMI decreased from 41.93±1.48 to 32.46±1.59, change from baseline -9.96±0.29 kg m(-2). CONCLUSIONS Testosterone therapy appears to be an effective approach to achieve sustained WL in obese hypogonadal men irrespective of severity of obesity. Based on these findings we suggest that T therapy offers safe and effective treatment strategy of obesity in hypogonadal men.
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Affiliation(s)
- F Saad
- Global Medical Affairs Andrology, Bayer Pharma, Berlin, Germany.,Department of Urology, Gulf Medical University, Ajman, UAE
| | - A Yassin
- Department of Urology, Gulf Medical University, Ajman, UAE.,Institute for Urology and Andrology, Segeberger Kliniken, Norderstedt, Germany.,Department of Preventive Medicine, Men's Health Program, Dresden International University, Dresden, Germany
| | - G Doros
- Department for Epidemiology and Statistics, Boston University School of Public Health, Boston, MA, USA
| | - A Haider
- Private Urology Practice, Bremerhaven, Germany
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Abstract
Testosterone is a key hormone in the pathology of metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly central adiposity) and reduced lean mass in males. These morphological features are linked to metabolic dysfunction, and testosterone deficiency is associated with energy imbalance, impaired glucose control, reduced insulin sensitivity and dyslipidaemia. A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels. Androgenic effects on enzymatic pathways of fatty acid metabolism, glucose control and energy utilization are apparent and often tissue specific with differential effects noted in different regional fat depots, muscle and liver to potentially explain the mechanisms of testosterone action. Testosterone replacement therapy demonstrates beneficial effects on measures of obesity that are partially explained by both direct metabolic actions on adipose and muscle and also potentially by increasing motivation, vigour and energy allowing obese individuals to engage in more active lifestyles. The degree of these beneficial effects may be dependent on the treatment modality with longer term administration often achieving greater improvements. Testosterone replacement may therefore potentially be an effective adjunctive treatment for weight management in obese men with concomitant hypogonadism.
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Affiliation(s)
- D M Kelly
- Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK
| | - T H Jones
- Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK.,Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
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Роживанов РВ, Яшина ЮН. Aspects of androgen replacement therapy for the treatment of hypogonadism in men with diabetes and metabolic syndrome. OBESITY AND METABOLISM 2015. [DOI: 10.14341/omet2015111-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The article presents the results of studies of efficacy and safety of androgen therapy for hypogonadism, metabolic syndrome and type 2diabetes mellitus in men. In the study was used testosterone undecanoate therapy which causes reduction of obesity, a decrease in theseverity of the other components of the metabolic syndrome, improving glycemic profile without significant side effects. Nevertheless,this therapy requires monitoring and management for risk factors.
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Fornari R, Francomano D, Greco EA, Marocco C, Lubrano C, Wannenes F, Papa V, Bimonte VM, Donini LM, Lenzi A, Aversa A, Migliaccio S. Lean mass in obese adult subjects correlates with higher levels of vitamin D, insulin sensitivity and lower inflammation. J Endocrinol Invest 2015; 38:367-72. [PMID: 25352234 DOI: 10.1007/s40618-014-0189-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/03/2014] [Indexed: 12/20/2022]
Abstract
AIM Several chronic metabolic alterations are present in obese subjects. While it is well known about the detrimental effect of abdominal adipose tissue on chronic metabolic clinical condition, less is known on the role of lean mass in obese subjects. Thus, the aim of our study was to evaluate the potential correlation of muscle mass, metabolic condition and inflammation status in obese individuals. METHODS The study included 426 obese subjects (86 men and 340 female; mean age 44.8 ± 14 years; BMI: 34.9 ± 6.1 kg/m(2)). Exclusion criteria were chronic medical conditions or use of medications affecting bone metabolism, alterations of hormonal and nutritional status, vitamin D supplementation, recent weight loss and prior bariatric surgery. Patients underwent measurements of bone mineral density (lumbar and hip) and body composition (lean mass, total and trunk fat mass) by dual X-ray absorptiometry and were evaluated for hormonal and metabolic profile and inflammatory markers. RESULTS Higher lean body mass (LM%) was inversely correlated with homeostasis model assessment of insulin resistance (p < 0.0091; r(2) 0.03938) and associated with lower fibrinogen levels (p < 0.0001; r(2) 0.1263). Interestingly, in obese subjects, LM% was associated with higher levels of vitamin D (p < 0.0001, r(2) 0.1140), osteocalcin (p < 0.0001, r(2) 0.2401) and insulin-like growth factor-1 (IGF-1) (p < 0.0002, r(2) 0.1367). CONCLUSION Our results show for the first time that in obese patients, higher amounts of lean mass are directly linked to a lower inflammatory profile and to better insulin sensitivity, but also to the presence of higher level of vitamin D and IGF-1. Moreover, these data suggest that higher levels of lean mass in obese people correlate with a better metabolic profile and, thus, strongly suggest the need to develop programs to facilitate an increase in physical activity in obese people.
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Affiliation(s)
- R Fornari
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - D Francomano
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - E A Greco
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
- LiSa Laboratory, Azienda Ospedaliera-Universitaria "Policlinico Vittorio Emanuele", University of Catania, Catania, Italy
| | - C Marocco
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - C Lubrano
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - F Wannenes
- LiSa Laboratory, Azienda Ospedaliera-Universitaria "Policlinico Vittorio Emanuele", University of Catania, Catania, Italy
- Department of Movement, Human and Health Sciences, Section of Health Sciences, University "Foro Italico" of Rome, Largo Lauro De Bosis 15, 00195, Rome, Italy
| | - V Papa
- Department of Movement, Human and Health Sciences, Section of Health Sciences, University "Foro Italico" of Rome, Largo Lauro De Bosis 15, 00195, Rome, Italy
| | - V M Bimonte
- LiSa Laboratory, Azienda Ospedaliera-Universitaria "Policlinico Vittorio Emanuele", University of Catania, Catania, Italy
- Department of Movement, Human and Health Sciences, Section of Health Sciences, University "Foro Italico" of Rome, Largo Lauro De Bosis 15, 00195, Rome, Italy
| | - L M Donini
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - A Lenzi
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - A Aversa
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
- LiSa Laboratory, Azienda Ospedaliera-Universitaria "Policlinico Vittorio Emanuele", University of Catania, Catania, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Section of Health Sciences, University "Foro Italico" of Rome, Largo Lauro De Bosis 15, 00195, Rome, Italy.
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Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc 2015; 90:224-51. [PMID: 25636998 DOI: 10.1016/j.mayocp.2014.10.011] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 01/25/2023]
Abstract
Two recent studies raised new concerns regarding cardiovascular (CV) risks with testosterone (T) therapy. This article reviews those studies as well as the extensive literature on T and CV risks. A MEDLINE search was performed for the years 1940 to August 2014 using the following key words: testosterone, androgens, human, male, cardiovascular, stroke, cerebrovascular accident, myocardial infarction, heart attack, death, and mortality. The weight and direction of evidence was evaluated and level of evidence (LOE) assigned. Only 4 articles were identified that suggested increased CV risks with T prescriptions: 2 retrospective analyses with serious methodological limitations, 1 placebo-controlled trial with few major adverse cardiac events, and 1 meta-analysis that included questionable studies and events. In contrast, several dozen studies have reported a beneficial effect of normal T levels on CV risks and mortality. Mortality and incident coronary artery disease are inversely associated with serum T concentrations (LOE IIa), as is severity of coronary artery disease (LOE IIa). Testosterone therapy is associated with reduced obesity, fat mass, and waist circumference (LOE Ib) and also improves glycemic control (LOE IIa). Mortality was reduced with T therapy in 2 retrospective studies. Several RCTs in men with coronary artery disease or heart failure reported improved function in men who received T compared with placebo. The largest meta-analysis to date revealed no increase in CV risks in men who received T and reduced CV risk among those with metabolic disease. In summary, there is no convincing evidence of increased CV risks with T therapy. On the contrary, there appears to be a strong beneficial relationship between normal T and CV health that has not yet been widely appreciated.
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Rotter I, Kosik-Bogacka D, Dołęgowska B, Skonieczna-Żydecka K, Pawlukowska W, Laszczyńska M. Analysis of relationships between the concentrations of total testosterone and dehydroepiandrosterone sulfate and the occurrence of selected metabolic disorders in aging men. Aging Male 2015; 18:249-55. [PMID: 26375874 DOI: 10.3109/13685538.2015.1077507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The evaluation of relationships between the concentrations of dehydroepiandrosterone sulfate (DHEAS) and total testosterone (TT) and the occurrence of metabolic disorders, including metabolic syndrome (MetS). METHOD The participants were subjected to anthropometric measurements and were tested for DHEAS, TT, lipid parameters and carbohydrate parameters. RESULT We observed a lower concentration of DHEAS in the men with hypertension (HT) compared to those without HT. In the men with MetS, HT, overweight and obesity, the concentration of TT was lower than in the men without these problems. We found statistically significant positive correlations (DHEAS- total cholesterol [TCh], DHEAS- low-density lipoprotein [LDL], TT- high-density lipoprotein [HDL], TT-waist-to-hip ratio [WHR]) and negative correlations (DHEAS-age, TT-body weight, TT- body mass index [BMI], TT-abdominal circumference [AC], TT-hip circumference [HC], TT- triglyceride [TG], TT- fasting plasma glucose [FPG], TT- serum insulin levels [I], TT- Homeostasis Model Assessment-Insulin Resistance [HOMA-IR]). Using logistic regression it was ascertained that lower TT levels increase the risk of HT, and were also associated with obesity. CONCLUSION Our research indicates relationships between TT and the occurrence of MetS and its individual components. Excess body weight in men is a factor associated with lower TT levels. It seems necessary to determine TT in men with MetS and overweight or obesity. DHEAS did not show any significant relations with MetS and its parameters. Age was the most crucial factor responsible for the decrease in DHEAS.
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Affiliation(s)
| | | | | | | | | | - Maria Laszczyńska
- e Department of Histology and Developmental Biology , Pomeranian Medical University , Szczecin , Poland
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58
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Saad F, Yassin A, Almehmadi Y, Doros G, Gooren L. Effects of long-term testosterone replacement therapy, with a temporary intermission, on glycemic control of nine hypogonadal men with type 1 diabetes mellitus - a series of case reports. Aging Male 2015; 18:164-8. [PMID: 26075537 DOI: 10.3109/13685538.2015.1034687] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is often associated with obesity and subnormal serum testosterone (T) levels. Until 5 years ago there was no indication that men with type 1 diabetes mellitus (T1DM) had subnormal serum T. But recent studies indicate that about 10% of men with T1DM suffer from hypogonadism, as a rule aged men and men with obesity. While hypogonadal men with T2DM benefit from normalization of their serum T, this has not been investigated in men with T1DM. Nine men with T1DM, erectile dysfunction and hypogonadism (total testosterone ≤ 12 nmol/L) received testosterone replacement therapy (TRT). In seven men TRT was intermitted: one man with prostate malignancy and six men because of problems of reimbursement. Incidentally, this provided an opportunity to monitor the effects of withdrawal and of the reinstatement of TRT. In all men, glycemic control (serum glucose and HbA1c), weight, waist circumference, lipid profiles and erectile function improved upon TRT. The seven men whose TRT was intermitted showed a deterioration which improved again upon reinstatement of TRT. The data suggest that aging and obese men with T1DM might have subnormal T levels and that their glycemic control, lipid profiles and erectile function might benefit from TRT.
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Affiliation(s)
- Farid Saad
- a Global Medical Affairs Men's Healthcare, Bayer Pharma AG , Berlin , Germany
| | - Aksam Yassin
- b Institute of Urology and Andrology, Segeberger Kliniken , Norderstedt , Germany
| | - Yousef Almehmadi
- b Institute of Urology and Andrology, Segeberger Kliniken , Norderstedt , Germany
| | - Gheorghe Doros
- c Department of Epidemiology and Statistics , Boston University School of Public Health , Boston , MA , USA , and
| | - Louis Gooren
- d Department of Internal Medicine , Endocrine Section, VU Medical Center , Amsterdam , The Netherlands
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Haider A, Zitzmann M, Doros G, Isbarn H, Hammerer P, Yassin A. Incidence of Prostate Cancer in Hypogonadal Men Receiving Testosterone Therapy: Observations from 5-Year Median Followup of 3 Registries. J Urol 2015; 193:80-6. [DOI: 10.1016/j.juro.2014.06.071] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/24/2022]
Affiliation(s)
| | - Michael Zitzmann
- Centre for Reproductive Medicine and Andrology / Clinical Andrology, University Clinics Muenster, Münster, Germany
| | - Gheorghe Doros
- Department of Epidemiology and Statistics, Boston University School of Public Health, Boston, Massachusetts
| | - Hendrik Isbarn
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Hammerer
- Department of Urology and Uro-Oncology, Klinikum Braunschweig, Braunschweig, Germany
| | - Aksam Yassin
- Institute of Urology and Andrology, Segeberger Kliniken, Norderstedt, Germany
- Dresden International University, Dresden, Germany
- Department of Urology, Gulf Medical University, Ajman, United Arab Emirates
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Hans SS, Dhindsa SS, Chemitiganti R. Testosterone Replacement and Cardiovascular Safety: No Straight and Narrow! CLINICAL MEDICINE INSIGHTS: CARDIOLOGY 2015; 9:33-7. [PMID: 25983562 PMCID: PMC4412415 DOI: 10.4137/cmc.s23395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/10/2015] [Accepted: 02/21/2015] [Indexed: 11/05/2022] Open
Abstract
The past decade has seen a tremendous increase in the number of men treated for hypogonadism with the expectation of symptomatic benefit. However, the long-term cardiovascular safety of testosterone replacement remains unknown because retrospective studies of testosterone replacement have been inconsistent, and definitive, prospective, randomized studies are lacking. The purpose of this review is to critically appraise the studies on testosterone replacement and cardiovascular outcomes.
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Affiliation(s)
- Sartaj S. Hans
- Division of Cardiology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandeep S. Dhindsa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Texas Tech University Health Sciences Center – Permian Basin Campus, Odessa, TX, USA
| | - Rama Chemitiganti
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Texas Tech University Health Sciences Center – Permian Basin Campus, Odessa, TX, USA
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Isidori AM, Balercia G, Calogero AE, Corona G, Ferlin A, Francavilla S, Santi D, Maggi M. Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. J Endocrinol Invest 2015; 38:103-12. [PMID: 25384570 PMCID: PMC4282686 DOI: 10.1007/s40618-014-0155-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 08/06/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We developed clinical practice guidelines to assess the individual risk-benefit profile of androgen replacement therapy in adult male hypogonadism (HG), defined by the presence of specific signs and symptoms and serum testosterone (T) below 12 nmol/L. PARTICIPANTS The task force consisted of eight clinicians experienced in treating HG, selected by the Italian Society of Endocrinology (SIE). The authors received no corporate funding or remuneration. CONSENSUS PROCESS Consensus was guided by a systematic review of controlled trials conducted on men with a mean T < 12 nmol/L and by interactive discussions. The guidelines were reviewed and sequentially approved by the SIE Guidelines Commission and Executive Committee. CONCLUSIONS We recommend T supplementation (TS) for adult men with severely reduced T levels (T < 8 nmol/L) to improve body composition and sexual function. We suggest that TS be offered to subjects with T < 12 nmol/L to improve glycaemic control, lipid profile, sexual function, bone mineral density, muscle mass and depressive symptoms, once major contraindications have been ruled out. We suggest that lifestyle changes and other available interventions (e.g. for erectile dysfunction) be suggested prior to TS. We suggest that TS should be combined with currently available treatments for individuals at high risk for complications, such as those with osteoporosis and/or metabolic disorders. We recommend against using TS to improve cardiac outcome and limited mobility. We recommend against using TS in men with prostate cancer, unstable cardiovascular conditions or elevated haematocrit. The task force places a high value on the timely treatment of younger and middle-aged subjects to prevent the long-term consequences of hypoandrogenism.
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Affiliation(s)
- A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Balercia
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - A E Calogero
- Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | - G Corona
- Medical Department Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - A Ferlin
- Department of Medicine, University of Padua, Padua, Italy
| | - S Francavilla
- Department of Life, Health and Environment Sciences, Andrology, and Epidemiology, University of L'Aquila, L'Aquila, Italy
| | - D Santi
- Department of Biosciences, Metabolism and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Firenze, Italy.
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Gårevik N, Rane A, Björkhem-Bergman L, Ekström L. Effects of different doses of testosterone on gonadotropins, 25-hydroxyvitamin D3, and blood lipids in healthy men. Subst Abuse Rehabil 2014; 5:121-7. [PMID: 25525405 PMCID: PMC4266340 DOI: 10.2147/sar.s71285] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS To study the effect and time profile of different doses of testosterone enanthate on the blood lipid profile and gonadotropins. EXPERIMENTAL DESIGN Twenty-five healthy male volunteers aged 27-43 years were given 500 mg, 250 mg, and 125 mg of testosterone enanthate as single intramuscular doses of Testoviron(®) Depot. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), blood lipid profile (total cholesterol, plasma [p-] low-density lipoprotein, p-high-density lipoprotein [HDL], p-apolipoprotein A1 [ApoA1], p-apolipoprotein B, p-triglycerides, p-lipoprotein(a), serum [s-] testosterone, and 25-hydroxyvitamin D3) were analyzed prior to, and 4 and 14 days after dosing. Testosterone and epitestosterone in urine (testosterone/epitestosterone ratio) were analyzed prior to each dose after a washout period of 6-8 weeks. RESULTS AND DISCUSSION All doses investigated suppressed the LH and FSH concentrations in serum. LH remained suppressed 6 weeks after the 500 mg dose. These results indicate that testosterone has a more profound endocrine effect on the hypothalamic-pituitary-gonadal axis than was previously thought. There was no alteration in 25-hydroxyvitamin D3 levels after testosterone administration compared to baseline levels. The 250 and 500 mg doses induced decreased concentrations of ApoA1 and HDL, whereas the lowest dose (125 mg) did not have any effect on the lipid profile. CONCLUSION The single doses of testosterone produced a dose-dependent increase in serum testosterone concentrations together with suppression of s-LH and s-FSH. Alterations in ApoA1 and HDL were observed after the two highest single doses. It is possible that long-time abuse of anabolic androgenic steroids will lead to alteration in vitamin D status. Knowledge and understanding of the side effects of anabolic androgenic steroids are important to the treatment and care of abusers of testosterone.
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Affiliation(s)
- Nina Gårevik
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Farias JM, Tinetti M, Khoury M, Umpierrez GE. Low testosterone concentration and atherosclerotic disease markers in male patients with type 2 diabetes. J Clin Endocrinol Metab 2014; 99:4698-703. [PMID: 25322269 PMCID: PMC4255118 DOI: 10.1210/jc.2014-2585] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Low total T is associated with an increased risk of atherosclerotic complications. However, the magnitude of this association in middle-aged patients with type 2 diabetes (T2D) has not been determined. MATERIALS AND METHODS This cross-sectional study evaluated atherosclerotic disease markers in T2D patients with normal and low plasma total T. A total of 115 male patients, aged younger than 70 years, without a history of cardiovascular events, and with normal [≥ 3.5 ng/mL (≥ 12.1 nmol/L), n = 79] or low [< 3.5 ng/mL (≤ 12.1 nmol/L), n = 36] total T underwent the measurement of highly sensitive C-reactive protein, carotid artery carotid intima-media thickness (IMT), and atherosclerotic plaque by high-resolution B-mode ultrasound and to asses endothelial function by brachial artery flow-mediated dilation. RESULTS Carotid IMT was negatively correlated with total T concentration (r = -0.39, P < .0001). Compared with subjects with normal T, a higher proportion of patients with low total T had carotid IMT of 0.1 cm or greater [80% vs 39%, odds ratio (OR) 6.41; 95% CI 2.5-16.4, P < .0001], atherosclerotic plaques (68.5% vs 44.8%, OR 2.60, 95% CI 1.12-6.03, P < .0001); endothelial dysfunction (80.5% vs 42.3%, OR 5.77, 95% CI 2.77-14.77, P < .003), and higher highly sensitive C-reactive protein levels (2.74 ± 5.82 vs 0.89 ± 0.88 mg/L, P < .0001). Similar results were found when free T was considered. Multiple logistic regression analyses adjusted for age, diabetes mellitus duration, hemoglobin A1c, lipids, treatment effect, and body mass index reported that a low total T level was independently associated with greater IMT [OR 8.43 (95% CI 2.5-25.8)] and endothelial dysfunction [OR 5.21 (95% CI 1.73-15.66)] but not with the presence of atherosclerotic plaques (OR 1.77, 95% CI 0.66-4.74). CONCLUSIONS Low T is associated with more advanced atherosclerotic disease markers in middle-aged patients with T2D.
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Affiliation(s)
- Javier M Farias
- Endocrinology Service (J.M.F.), Research and Statistics Service (M.K.), Sanatorio Guemes, Ciudad Autonoma de Buenos Aires, C1188AAX Argentina; Cardiologic Image (M.T.), Sanatorio Trinidad Palermo, Ciudad Autonoma de Buenos Aires, C1425AIC Argentina; and Department of Medicine (G.E.U.), Emory University, Atlanta, Georgia 30322
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Abstract
PURPOSE OF REVIEW The purpose of this article is to examine the contemporary data linking testosterone therapy in overweight and obese men with testosterone deficiency to increased lean body mass, decreased fat mass, improvement in overall body composition and sustained weight loss. This is of paramount importance because testosterone therapy in obese men with testosterone deficiency represents a novel and a timely therapeutic strategy for managing obesity in men with testosterone deficiency. RECENT FINDINGS Long-term testosterone therapy in men with testosterone deficiency produces significant and sustained weight loss, marked reduction in waist circumference and BMI and improvement in body composition. Further, testosterone therapy ameliorates components of the metabolic syndrome. The aforementioned improvements are attributed to improved mitochondrial function, increased energy utilization, increased motivation and vigor resulting in improved cardio-metabolic function and enhanced physical activity. SUMMARY The implication of testosterone therapy in management of obesity in men with testosterone deficiency is of paramount clinical significance, as it produces sustained weight loss without recidivism. On the contrary, alternative therapeutic approaches other than bariatric surgery failed to produce significant and sustained outcome and exhibit a high rate of recidivism. These findings represent strong foundations for testosterone therapy in obese men with testosterone deficiency and should spur clinical research for better understanding of usefulness of testosterone therapy in treatment of underlying pathophysiological conditions of obesity.
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Affiliation(s)
- Abdulmaged M Traish
- Departments of Biochemistry and Urology, Boston University School of Medicine, Boston, Massachusetts, USA
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Corona G, Maseroli E, Maggi M. Injectable testosterone undecanoate for the treatment of hypogonadism. Expert Opin Pharmacother 2014; 15:1903-26. [DOI: 10.1517/14656566.2014.944896] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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