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Siltari A, Murtola TJ, Kausz J, Talala K, Taari K, Tammela TL, Auvinen A. Testosterone replacement therapy is not associated with increased prostate cancer incidence, prostate cancer-specific, or cardiovascular disease-specific mortality in Finnish men. Acta Oncol 2023; 62:1898-1904. [PMID: 37971326 DOI: 10.1080/0284186x.2023.2278189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Concerns have been expressed over the safety of testosterone replacement therapy (TRT) in men with late-onset hypogonadism (LOH). Previous studies have shown controversial results regarding the association of TRT with the risk of cardiovascular events or prostate cancer (PCa) incidence, aggressiveness, and mortality. This study explores the overall risk of PCa and risk by tumor grade and stage, as well as mortality from PCa and cardiovascular disease (CVD), among men treated with TRT compared to men without LOH and TRT use. MATERIALS AND METHODS The study included 78,615 men of age 55-67 years at baseline from the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC). Follow-up started at randomization and ended at death, emigration, or a common closing date January 1st, 2017. Cox proportional hazards regression model with time-dependent variables and adjustment for age, trial arm, use of other medications, and Charlson comorbidity index was used. Comprehensive information on TRT purchases during 1995-2015 was obtained from the Finnish National Prescription Database. PCa cases were identified from the Finnish Cancer Registry and causes of death obtained from Statistics Finland. RESULTS Over the course of 18 years of follow-up, 2919 men were on TRT, and 285 PCa cases were diagnosed among them. TRT users did not exhibit a higher incidence or mortality rate of PCa compared to non-users. On the contrary, men using TRT had lower PCa mortality than non-users (HR = 0.52; 95% CI 0.3-0.91). Additionally, TRT users had slightly lower CVD and all-cause mortality compared to non-users (HR = 0.87; 95% CI 0.75-1.01 and HR = 0.93; 95% CI 0.87-1.0, respectively). No time- or dose-dependency of TRT use was evident in any of the analyses. CONCLUSION Men using TRT were not associated to increased risk for PCa and did not experience increased PCa- or CVD-specific mortality compared to non-users. Further studies considering blood testosterone levels are warranted.
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Affiliation(s)
- Aino Siltari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Faculty of Medicine, Pharmacology, University of Helsinki, Helsinki, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Josefina Kausz
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teuvo Lj Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Tampere University, Faculty of Social Sciences, Tampere, Finland
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Singh J, Sahoo AK, Swain J, Mangaraj S, Kanwar JB, Manglunia A. Assessment of hypogonadism and its determinants among adult men with type 2 diabetes mellitus. Prim Care Diabetes 2023:S1751-9918(23)00099-2. [PMID: 37188551 DOI: 10.1016/j.pcd.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/31/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND AIMS The impact of utilizing both symptoms as well as biochemically confirmed androgen deficiency in diagnosis of hypogonadism among type 2 diabetic men is relatively less studied. Furthermore, various determinants of hypogonadism in these men especially the role of insulin resistance and hypogonadism were studied. METHODS This is a cross sectional study of 353 T2DM men aged 20-70 years of age. Hypogonadism was defined by taking both symptoms as well as calculated testosterone levels. Symptoms were defined using androgen deficiency in ageing male (ADAM) criteria. Various metabolic and clinical parameters were assessed and evaluated with regards to presence or absence of hypogonadism. RESULTS Among 353 patients, 60 had both symptoms as well as biochemical evidence of hypogonadism. Assessment of calculated free testosterone but not total testosterone identified all such patients. Body mass index, HbA1c, fasting triglyceride level and HOMA IR inversely correlated with calculated free testosterone. We found that insulin resistance (HOMA IR) was independently associated with hypogonadism (odds ratio=1.108). CONCLUSION Assessment of both symptoms of hypogonadism and calculated free testosterone represents a better way for correct identification of hypogonadal diabetic men. Insulin resistance has a strong association with hypogonadism independent of obesity and complication status of diabetes.
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Affiliation(s)
- Jaspreet Singh
- Department of Endocrinology, IMS & SUM Medical College and Hospital, Bhubaneswar, Odisha, India
| | - Abhay Kumar Sahoo
- Department of Endocrinology, IMS & SUM Medical College and Hospital, Bhubaneswar, Odisha, India
| | - Jayshree Swain
- Department of Endocrinology, IMS & SUM Medical College and Hospital, Bhubaneswar, Odisha, India.
| | - Swayamsidha Mangaraj
- Department of Endocrinology, IMS & SUM Medical College and Hospital, Bhubaneswar, Odisha, India
| | - Jaya Bhanu Kanwar
- Department of Endocrinology, IMS & SUM Medical College and Hospital, Bhubaneswar, Odisha, India
| | - Ankit Manglunia
- Department of Endocrinology, IMS & SUM Medical College and Hospital, Bhubaneswar, Odisha, India
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Anupam B, Shivaprasad C, Vijaya S, Sridevi A, Aiswarya Y, Nikhil K. Prevalence of hypogonadism in patients with type 2 diabetes mellitus among the Indian population. Diabetes Metab Syndr 2020; 14:1299-1304. [PMID: 32755825 DOI: 10.1016/j.dsx.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine the prevalence of hypogonadism among Indian men with and without type 2 diabetes mellitus (T2DM) and evaluate its association with various metabolic parameters. METHODS One hundred fifty consecutive men with T2DM, aged 25-70 years, and one hundred age-matched healthy men without diabetes were included. The free testosterone (FT) level was calculated using the total testosterone (TT), sex hormone-binding globulin (SHBG), and albumin levels in serum. Patients with a calculated FT level <6.35 ng/dL and a positive response on the androgen deficiency in aging male questionnaire (ADAM) were diagnosed with hypogonadism. RESULTS The prevalence of hypogonadism was 17.3% and 10% in men with and without T2DM, respectively. The body mass index (BMI) and the mean levels of follicle-stimulating hormone (FSH), TT, SHBG, Triglycerides (TG), and FT were significantly different between the groups. The mean BMI and TG levels were significantly higher in patients with T2DM than in those without. Both groups showed a significant negative correlation between the BMI and SHBG level. CONCLUSION The hypogonadism prevalence was higher in patients with T2DM than in those without, although the difference did not reach statistical significance.
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Lenfant L, Leon P, Cancel-Tassin G, Audouin M, Staerman F, Rouprêt M, Cussenot O. Testosterone replacement therapy (TRT) and prostate cancer: An updated systematic review with a focus on previous or active localized prostate cancer. Urol Oncol 2020; 38:661-670. [DOI: 10.1016/j.urolonc.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 02/01/2023]
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Anupam B, Shivaprasad C, Sridevi A, Aiswarya Y, Gautham K, Ramdas B, Kejal S. Association of total and calculated free testosterone with androgen deficiency symptoms in patients with type 2 diabetes. Int J Impot Res 2019; 32:289-296. [PMID: 31000814 DOI: 10.1038/s41443-019-0144-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 12/13/2022]
Abstract
The Androgen Deficiency in the Aging Male (ADAM) questionnaire is commonly used to screen type 2 diabetes mellitus (T2DM) patients for androgen deficiency symptoms, but the association of low total (TT) and free testosterone (FT) levels with divergent responses to the ADAM questionnaire remains unclear. The aim of this study was to assess the predictive ability of TT and calculated FT (cFT) levels for accurately classifying ADAM status. We recruited 70 patients each with positive (group A) and negative (group B) responses to the ADAM questionnaire and 70 age-matched healthy controls (group C) (mean age, 50.5 years); serum levels of TT were estimated and cFT were estimated using Vermeulen equation. Hypogonadism was defined as the presence of symptoms (positive ADAM score) along with TT level < 300 ng/dL or calculated (cFT) <6.35 ng/dL. BMI was highest in group A (P < 0.05), followed by groups B and C. Group A had longer diabetes durations (P < 0.05) and higher fasting plasma glucose (FPG) and HbA1c levels than group B (P < 0.001). TT levels and cFT were significantly lower in Group A than in the other two groups. In group A, 51 (73%) men had low TT levels (<300 ng/dL) and 48 (69%) had low cFT (<6.35 ng/dL). TT levels < 300 ng/dL had higher sensitivity and specificity (73 and 96%, respectively) than cFT < 6.35 ng/dL (69 and 90%, respectively) for predicting ADAM status. Multivariate-adjusted logistic regression showed that diabetes duration, HbA1c level, and BMI predicted low TT levels, whereas diabetes duration and HbA1c and high-density lipoprotein levels were significant predictors of low cFT. TT levels were a better predictor of ADAM responses than cFT in male T2DM patients. Our results suggest that TT level is better than cFT for diagnosing hypogonadism in T2DM patients when equilibrium dialysis is not feasible.
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Affiliation(s)
- Biswas Anupam
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Channabasappa Shivaprasad
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
| | - Atluri Sridevi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Yalamanchi Aiswarya
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Kolla Gautham
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Barure Ramdas
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Shah Kejal
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
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Arver S, Stief C, de la Rosette J, Jones TH, Neijber A, Carrara D. A new 2% testosterone gel formulation: a comparison with currently available topical preparations. Andrology 2018; 6:396-407. [PMID: 29600542 DOI: 10.1111/andr.12487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/19/2018] [Accepted: 03/01/2018] [Indexed: 12/22/2022]
Abstract
Testosterone gel formulations have become a popular testosterone replacement therapy in patients with hypogonadism since their advent in the year 2000. The gel formulations restore testosterone levels to mid-normal physiological levels (14-17.5 nmol/L) as early as within 24 h, and help alleviate the signs and symptoms of testosterone deficiency, thereby leading to an improved quality of life. Although testosterone gels have a favourable efficacy and safety profile as compared to injectable and patch formulations, risk of secondary exposure poses a challenge. Approved testosterone topical formulations include Tostrex® (Tostran® , Fortesta® ), Androgel® (Testogel® ), Testim® and Axiron® (solution), which have a favourable efficacy profile and positively impacted patient-reported outcome(s). Besides, Testavan, which is a 2% testosterone gel, is under registration in Europe and already approved in Australia in May 2017. Testavan uses a novel hydroalcoholic and highly viscous topical formulation. This product comes with a metered dose dispenser and a cap applicator that allows a hands-free application for precise dispensing and application. The present article provides a comprehensive review of pharmacokinetic, tolerability and safety profile of the testosterone gels available in the market along with the new 2% testosterone gel, Testavan.
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Affiliation(s)
- S Arver
- Karolinska Institute, Stockholm, Sweden
| | - C Stief
- Department of Urology, Ludwig-Maximilians-Universität München, München, Germany
| | - J de la Rosette
- AMC University Hospital, Amsterdam-Zuidoost, The Netherlands
| | - T H Jones
- Robert Hague Centre for Diabetes and Endocrinology, Barnsley and Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - A Neijber
- International Pharma Science Center, Ferring Pharmaceuticals, Copenhagen, Denmark
| | - D Carrara
- Ferring Galenisches Labor AG, Allschwil, Switzerland
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Wolf J, Keipert D, Motazedi H, Ernst M, Nettleship J, Gooren L. Effectiveness and tolerability of parenteral testosterone undecanoate: a post-marketing surveillance study. Aging Male 2017; 20:225-234. [PMID: 28812471 DOI: 10.1080/13685538.2017.1364234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This observational post-marketing study of parenteral testosterone undecanoate (TU) in a non-selected population aimed to: examine the effectiveness of TU as treatment of hypogonadism; record adverse drug reactions (ADR) quantitatively particularly regarding polycythemia, prostate safety and cardiovascular-related metabolic risk factors; and verify whether recommended injection intervals apply to routine clinical practice. Eight hundred and seventy subjects from 259 outpatient units scheduled to visit the clinic six times were included. Effectiveness and tolerability of TU administration were assessed on a 4-point scale. Body weight, waist girth, blood pressure, hemoglobin levels, hematocrit, prostate-specific antigen (PSA), and digital rectal prostate examination were assessed. Over 90% of subjects completed the observational duration of 52.8 ± 9.7 weeks (mean ± SD) and 56% judged effectiveness as very good, 30.8% as good. 63.1% judged tolerability as very good, and 24.4% as good. No adverse effects on indicators of cardiovascular risk were observed. Polycythemia occurred in one subject and a supranormal hematocrit in one subject. Four subjects developed supranormal PSA levels. Prostate carcinoma was found in one subject, one subject had recurrence of a previously surgically treated prostate carcinoma, and the other two showed no indication of malignancy. Parenteral TU is safe, effective, and well-tolerated in clinical practice proving a good therapeutic option for hypogonadism.
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Affiliation(s)
- Jan Wolf
- a Urologische Facharztpraxis , Frankenwaldklinik , Kronach , Germany
| | | | | | | | - Joanne Nettleship
- e Department of Oncology and Metabolism , University of Sheffield , Sheffield , UK
| | - Louis Gooren
- f Department of Internal Medicine , Endocrine Section, VU Medical Centre , Amsterdam , The Netherlands
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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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