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Abstract
Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of testosterone in the 1930s, commercialization of testosterone and synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for testosterone remains in replacement therapy for pathological hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation. Over recent decades, this created an epidemic of testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or obesity, where efficacy and safety remains unproven and doubtful. Androgen abuse originated during the Cold War as an epidemic of androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of drug abuse in sufficiently affluent communities that support an illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of testosterone, defined as prescribing without valid clinical indications, and abuse of testosterone or synthetic androgens (androgen abuse), defined as the illicit use of androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Andrology Department, Concord Hospital, Sydney, Australia
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2
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Abstract
Over the past decade, there has been a substantial increase in the number of men who are treated with testosterone. Despite this increase in the use of testosterone, the risks of adverse cardiovascular events are unclear as meta-analyses have reported conflicting findings and no clinical studies have been large enough or long enough to adequately assess for cardiovascular risks. The goal of this paper is to review large prescription database studies of testosterone treatment and adverse cardiovascular events and mortality with the aim of providing some guidance for clinicians and researchers in this controversial area.
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Affiliation(s)
- Molly M Shores
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, VA Puget Sound Health Care System, 1660 South Columbian Way Seattle, WA 98108, USA
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Vázquez-Mourelle R, Carracedo-Martinez E, Figueiras A. Impact of Health Authority Control Measures Aimed at Reducing the Illicit Use of Anabolic-Androgenic Steroids. Eur Addict Res 2018; 24:28-36. [PMID: 29448243 DOI: 10.1159/000486852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/15/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate two interventions on anabolic-androgenic-steroids (AAS) dispensation in retail pharmacies. MATERIAL AND METHODS The study was conducted in a north-western region of Spain. Data were the AAS supplied by wholesale drug distributors to retail pharmacies over a period of 102 months. It is designed as an ecological time-series study; the dependent variables were daily defined doses per 1,000 inhabitants per day of each drug. The two interventions evaluated were: (1) an inspection program intended for those retail pharmacies where there was an irregular dispensation and (2) a regulation put forth forcing these pharmacies to carry out additional registers. The medications studied were stanozolol, nandrolone, methenolone, testosterone and mesterolone. RESULTS The pre-intervention use of AAS displayed a rising trend. There was an immediate reduction of 30.56% after the first intervention, and a further reduction of 35.25% after the second. There was a seasonal pattern of use in the pre-intervention period, pointing to an increased demand at the end of spring and beginning of summer. The most abused drugs were stanozolol and nandrolone. CONCLUSION The health actions were very effective, in that they brought about a sharp reduction in the illicit use of AAS. These interventions could be applied to other drugs in which abuse were detected.
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Affiliation(s)
- Raquel Vázquez-Mourelle
- Deputy Manager Galician Health Service (Servicio Gallego de Salud - SERGAS), Galicia Regional Authority, Santiago de Compostela, Spain
| | | | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela and Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Handelsman DJ. Pharmacoepidemiology of testosterone: Curbing off-label prescribing. Pharmacoepidemiol Drug Saf 2017; 26:1248-1255. [DOI: 10.1002/pds.4284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/10/2022]
Affiliation(s)
- David J. Handelsman
- ANZAC Research Institute; University of Sydney; Sydney New South Wales Australia
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Translational Perspective on the Role of Testosterone in Sexual Function and Dysfunction. J Sex Med 2017; 13:1183-98. [PMID: 27436075 DOI: 10.1016/j.jsxm.2016.06.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/13/2016] [Accepted: 06/09/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The biological importance of testosterone is generally accepted by the medical community; however, controversy focuses on its relevance to sexual function and the sexual response, and our understanding of the extent of its role in this area is evolving. AIM To provide scientific evidence examining the role of testosterone at the cellular and molecular levels as it pertains to normal erectile physiology and the development of erectile dysfunction and to assist in guiding successful therapeutic interventions for androgen-dependent sexual dysfunction. METHODS In this White Paper, the Basic Science Committee of the Sexual Medicine Society of North America assessed the current basic science literature examining the role of testosterone in sexual function and dysfunction. RESULTS Testosterone plays an important role in sexual function through multiple processes: physiologic (stimulates activity of nitric oxide synthase), developmental (establishes and maintains the structural and functional integrity of the penis), neural (development, maintenance, function, and plasticity of the cavernous nerve and pelvic ganglia), therapeutically for dysfunctional regulation (beneficial effect on aging, diabetes, and prostatectomy), and phosphodiesterase type 5 inhibition (testosterone supplement to counteract phosphodiesterase type 5 inhibitor resistance). CONCLUSION Despite controversies concerning testosterone with regard to sexual function, basic science studies provide incontrovertible evidence for a significant role of testosterone in sexual function and suggest that properly administered testosterone therapy is potentially advantageous for treating male sexual dysfunction.
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Abstract
PURPOSE OF REVIEW There has been an increase in the prescribing of testosterone therapy in the past decade. There is concern that at least part of this increase is driven by advertising rather than sound medical practice. The purpose of this review is to summarize the recent trends in testosterone prescribing, and to examine whether testosterone is being appropriately prescribed as per guidelines. RECENT FINDINGS Both global and U.S. data reflect an overall increase in the use of testosterone in the last decade, although there are early signs of a decline in testosterone sales since 2014. This increased prescribing has been accompanied with an overall increase in testing for testosterone levels, prescription of testosterone without the appropriate diagnostic evaluation recommended by clinical practice guidelines, and apparent use of this therapy for unproven medical conditions. SUMMARY Research to date suggests that there is room to improve our prescribing of testosterone. Greater understanding of the potential provider-level and system-level factors that contribute to the current prescribing practices may help accomplish such improvement.
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Affiliation(s)
- Guneet K Jasuja
- aCenter for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford. bDepartment of Health Law, Policy and Management, Boston University School of Public Health, Boston cResearch Program in Men's Health, Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston dRAND Corporation, Boston, MA eDepartment of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Anaissie J, DeLay KJ, Wang W, Hatzichristodoulou G, Hellstrom WJ. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol 2017; 6:183-191. [PMID: 28540225 PMCID: PMC5422691 DOI: 10.21037/tau.2016.11.16] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The global prevalence of testosterone deficiency (TD) ranges from 10–40%. The actual diagnosis of TD is controversial, as a wide range of total testosterone (TT) thresholds are used for diagnosis (200–400 ng/dL), and physicians differ in their emphasis placed on clinical symptoms. There are also significant global differences in the prescription patterns of testosterone replacement therapy (TRT). In the United States, prescription of TRT is significantly higher than the rest of the world, increasing 3-fold over the last 10 years and more so in eugonadal men. The majority of treating physicians emphasizes clinical symptomology of TD over laboratory values, and up to one-fourth of their patients do not even have serum testosterone levels. There are significant inter-physician differences in willingness to prescribe TRT in the setting of prostate cancer. Data is scarce on testosterone prescribing patterns in Africa, Asia, and the Middle East. More literature is needed to better characterize how physicians from different regions diagnose TD.
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Affiliation(s)
- James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kent J DeLay
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - William Wang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Wayne J Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Martins D, Yao Z, Tadrous M, Shah BR, Juurlink DN, Mamdani MM, Gomes T. The appropriateness and persistence of testosterone replacement therapy in Ontario. Pharmacoepidemiol Drug Saf 2016; 26:119-126. [DOI: 10.1002/pds.4083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Diana Martins
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Zhan Yao
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Mina Tadrous
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto Ontario Canada
| | - Baiju R. Shah
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Department of Medicine; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - David N. Juurlink
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Department of Pediatrics; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Department of Medicine; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Muhammad M. Mamdani
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto Ontario Canada. St. Michael's Hospital; Toronto Ontario Canada
| | - Tara Gomes
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto Ontario Canada
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Mascarenhas A, Khan S, Sayal R, Knowles S, Gomes T, Moore JE. Factors that may be influencing the rise in prescription testosterone replacement therapy in adult men: a qualitative study. Aging Male 2016; 19:90-5. [PMID: 26927629 DOI: 10.3109/13685538.2016.1150994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore and describe the factors that may be influencing the rise of prescribing and use of testosterone replacement therapy (TRT) in adult men. DESIGN A rapid qualitative research design using semi-structured interviews with providers and patients. SETTING Ontario, Canada. PARTICIPANTS Nine men who have used TRT (referred to as "patients"), and six primary care clinicians and seven specialists (collectively referred to as "providers") who prescribed or administered TRT. METHOD Patients' and providers' perspectives were investigated through semi-structured interviews. A purposive sampling approach was used to recruit all participants. We conducted qualitative analysis using the framework approach for applied health research. MAIN FINDINGS Participants perceived the following factors to have influenced TRT prescriptions and use in adult men: provider factors (diagnostic ambiguity of age-related hypogonadism and beliefs about appropriateness of TRT) and patient factors (access to information on TRT and drug seeking behavior). They perceived that these factors have perpetuated a rise in prescription in the absence of clear clinical guidelines and unclear research evidence on the safety and efficacy of TRT. CONCLUSION The findings of this study highlight that much work still needs to be done to improve diagnostic accuracy and encourage appropriate TRT prescription in adult men. In addition, both patients and providers need more information about the risks and long-term effects of TRT in men.
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Affiliation(s)
- Alekhya Mascarenhas
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Sobia Khan
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Radha Sayal
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Sandra Knowles
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Tara Gomes
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
- b The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada , and
- c Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada
| | - Julia E Moore
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
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Tadrous M, Martins D, Lee K, Knowles S, Mamdani MM, Juurlink DN, Gomes T. Variations in costs and use of provincially-funded testosterone replacement therapy across Canada: a population-based study. Expert Rev Pharmacoecon Outcomes Res 2016; 16:803-807. [PMID: 26986676 DOI: 10.1586/14737167.2016.1167600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Provincial drug-program policies for the reimbursement of testosterone replacement therapy (TRT) vary across Canada, which may result in marked regional variability in use. METHODS We conducted a population-based cross-sectional analysis of provincially funded TRT spending and utilization in eight provinces across Canada in 2012. We reported the annual cost per user, total cost, and rate of use of TRT overall and by formulation. RESULTS We identified 23,544 provincially-funded recipients of TRT in 2012 in the eight provinces studied. Average annual cost per person varied by 3-fold, ranging from $173 (Prince Edward Island) to $485 (Ontario). Ontario also had the highest rate of use (1,105 users per 100,000 eligible) and the most liberal listing. Provinces with more restricted access (Alberta, British Columbia, and PEI) had lower annual costs per user ($293, $206, $173, respectively). CONCLUSIONS Differing reimbursement policies for TRT products across Canada are likely contributing to variation in the rate of use and cost per recipient.
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Affiliation(s)
- Mina Tadrous
- a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.,b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.,c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
| | - Diana Martins
- b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada
| | - Kathy Lee
- d Canadian Institute for Health Information , Ottawa , ON , Canada
| | - Sandra Knowles
- a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.,c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
| | - Muhammad M Mamdani
- a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.,c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.,e The Sunnybrook Research Institute , Toronto , ON , Canada.,f Department of Medicine , St. Michael's Hospital , Toronto , ON , Canada.,g Department of Medicine , University of Toronto , Toronto , ON , Canada.,h Departments of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada
| | - David N Juurlink
- b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.,g Department of Medicine , University of Toronto , Toronto , ON , Canada.,h Departments of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada.,i Departments of Pediatrics , University of Toronto , Toronto , ON , Canada
| | - Tara Gomes
- a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.,b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.,c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.,h Departments of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada
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12
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Bjerkeli PJ, Mulinari S, Merlo J. Testosterone prescribing in the population-a short social epidemiological analysis in Sweden. Pharmacoepidemiol Drug Saf 2015. [PMID: 26216248 DOI: 10.1002/pds.3836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE In recent years, there has been an increased interest for use of pharmaceutical testosterone among elderly men. However, it is still scarcely studied if this use is conditioned by socioeconomic factors in the general population of elderly men. METHODS Using individual-level data from a population-based cohort of men aged 65-84 years in the County Scania, Sweden, we analysed testosterone use in 2006 in relation to demographic and socioeconomic factors by means of multiple logistic regression. We also analysed national data at the ecological level to investigate trends in prescribing between 2006 and 2014. RESULTS The prevalence of testosterone use in Sweden among 65- to 84-year-old men increased by 83%, from 3.3 per 1000 men in 2006 to 6.0 in 2014. Testosterone use was more than twice as common in men in the highest income quintile compared with those in the lowest (0.68% versus 0.25%, odds ratio 2.69 and 95% confidence interval 1.80-4.02). Besides in the high-income group, testosterone use was highest in 65- to 69-year-old men, divorced men and, specially, in men with a previous hospital diagnose of hypogonadism. CONCLUSIONS Our findings show socioeconomic inequities in prescription of testosterone. This is a short analysis based on limited data, but because information on this topic is scarce, our analysis adds a relevant piece of evidence and highlights the need for further research.
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Affiliation(s)
- Pernilla J Bjerkeli
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Shai Mulinari
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
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Walsh TJ, Shores MM, Fox AE, Moore KP, Forsberg CW, Kinsey CE, Heckbert SR, Zeliadt S, Thompson ML, Smith NL, Matsumoto AM. Recent trends in testosterone testing, low testosterone levels, and testosterone treatment among Veterans. Andrology 2015; 3:287-92. [PMID: 25684636 DOI: 10.1111/andr.12014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/09/2014] [Accepted: 01/06/2015] [Indexed: 11/30/2022]
Abstract
Low serum testosterone (T) is common and increasingly prevalent with increased age. Recent studies report an 'epidemic' of T prescribing and concern about unnecessary T treatment. We investigated the number of men tested for T, the prevalence of low serum T levels, and initiation of T treatment among those with low T levels in men treated at Veterans Affairs (VA) facilities in the Northwest US (VISN 20). We identified male Veterans aged 40-89 years and examined yearly proportions of men tested for T, found to have low T levels (total T < 280 ng/dL, free T < 34 pg/mL, or bioavailable T < 84 ng/dL), and subsequently treated with T from 2002 to 2011. We excluded men who had T treatment in the year prior and men with diagnoses of prostate or breast cancer. Treatment initiation was defined as the first prescription for T within a year following a low T test. From 2002 to 2011, the yearly population of eligible men in VISN 20 increased from 129 247 to 163 572. The proportion of men who had serum T tests increased from 3.2% in 2002 to 5.8% in 2011. Among the tested men, the percentage of men with low T levels increased from 35.0 to 47.3%. However, the proportion of men with low T levels who were given T treatment within a year decreased from 31.0 to 28.0%. Despite large increases in T testing, and detection of men with low T levels, there was a slight decrease in the proportion of men with low T levels who were treated with T. The decrease in T treatment during this time period contrasts with other studies and may be related to higher comorbidity in Veterans and/or VA formulary restrictions on the use of transdermal T formulations.
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Affiliation(s)
- T J Walsh
- University of Washington, Seattle, WA, USA
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Carruthers M, Cathcart P, Feneley MR. Evolution of testosterone treatment over 25 years: symptom responses, endocrine profiles and cardiovascular changes. Aging Male 2015. [PMID: 26218766 PMCID: PMC4732450 DOI: 10.3109/13685538.2015.1048218] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Testosterone treatment has evolved rapidly over the past 25 years as new, more effective and convenient methods have become available. This study reports experience with seven different methods, introduced on the market in the UK. AIM To establish the symptom response when testosterone treatment was initiated on the basis of clinical features and symptoms of androgen deficiency, and the resulting endocrine, biochemical and physiological responses. METHODS Of 2693 patients attending the 3 Men's Health Centers - The UK Androgen Study (UKAS), 2247 were treated. Treatments included pellet implants, oral testosterone undecanoate (Testocaps), mesterolone (Proviron), testosterone gel (Testogel), testosterone scrotal cream (Andromen) and scrotal gel (Tostran). RESULTS There was no correlation between initial testosterone level, initial symptom score or the success of treatment as defined by adequate resolution of symptoms. Despite the diverse endocrine patterns produced, the testosterone preparations appear equally safe over prolonged periods, with either no change or improvement of cardiovascular risk factors, especially in lowering cholesterol and diastolic blood pressure. CONCLUSIONS It is suggested that because of excessive reliance on laboratory measures of androgens and undue safety concerns, many men who could benefit from symptom relief, improvement in related clinical conditions and given preventive medical benefits remain untreated.
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Affiliation(s)
- Malcolm Carruthers
- Centre for Men’s HealthLondon,
UK
- Alzheimer's and Ageing Department, Edith Cowan University,
Perth,
WA,
Australia
- Address for correspondence: Malcolm Carruthers,
Centre for Men's Health, 96 Harley Street,
London, W1G 7HY,
UK. E-mail:
| | - Paul Cathcart
- Department of Urology, University College Hospital,
London,
UK
| | - Mark R. Feneley
- Department of Urology, University College Hospital,
London,
UK
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